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Reassign Formulary Notice

What is it?

You'll get this notice if you get Extra Help and Medicare reassigned you into a new Medicare drug plan for the coming year. This blue notice tells you which of the Medicare Part D drugs you take will be covered in your new Medicare drug plan.

When should I get it?

December

Who sends it?

Medicare

What should I do if I get this notice?

Download a sample

"Formulary Reassignment Notice: Plan Premium Increase [PDF, 592 KB]"  Get this notice in Spanish [PDF, 647 KB].

"Formulary Reassignment Notice: Plan Termination [PDF, 593 KB]" Get this notice in Spanish [PDF, 634 KB].

Publication, product, or other number

Product No. 11475

Product No. 11496

Unofficial name

Blue notice