Medicare Monday: What You Need To Know About Part D Appeals
Medicare Monday: Did you know there is a process in Medicare Part D to appeal a coverage decision made by your plan about a medicine you need?
Medicare Monday: Did you know there is a process in Medicare Part D to appeal a coverage decision made by your plan about a medicine you need?
Did you know there is a process in Medicare Part D to appeal a coverage decision made by your plan about a medicine you need? Meaning, if a beneficiary is told at the pharmacy counter that his or her medicine isn’t covered or if they disagree with the cost-sharing amount, that isn’t the end of the line.
Every Part D beneficiary is entitled to request a written explanation from their plan about whether a certain medicine is covered, what the requirements are to receive a treatment and how much it will cost. This is called a coverage determination. If you or your doctor disagree with a coverage determination made by your plan, you have the right to appeal this decision.
The appeals process exists to help ensure beneficiaries don’t stop taking needed medicines and can avoid more serious and costly health outcomes. Here is what you should know about appealing a coverage determination:
For more information on appeals, check out these resources:
As we noted last week’s Medicare Monday blog, an individual’s ability to get access and adhere to their prescription medicine regimen can help beneficiaries with a number of different conditions achieve better health outcomes and also save money. To learn more, check out the resources above, and we encourage you to stay-tuned in the coming weeks for more on how the Part D program helps beneficiaries get the medicines they need.
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