Step 1—Dr. Smith wants to prescribe a new sleeping pill to treat Mr. Mason’s occasional insomnia. There is more than one type of sleeping pill available. Some of the drugs Dr. Smith considers prescribing are brand-name only prescription drugs covered by Mr. Mason’s Medicare drug plan. The plan rules require Mr. Mason to use the generic prescription drug zolplidem first. For most people, zolplidem works as well as brand-name prescription drugs.

Step 2—If Mr. Mason takes zolplidem but has side effects, his doctor can provide that information to the plan to seek approval to prescribe a brand-name drug. If approved, Mr. Mason’s Medicare drug plan will now cover the drug.