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Hoping someone can help with a question I have about Part D. If a medication is not on the formulary and no exception has been made by the carrier as an approved drug does it still track toward the TROOP and the ICL?
If the pharmacy can submit the medication to the insurance company and get a paid claim (even if the insurance pays no money towards the medication), it will be picked up by the system towards the TROOP, etc. If the claim is simply rejected by the insurance, it will not count towards those totals.
That is correct, but I've seen it go the way of "not applying" more often than not.