Jackpine Elders

Inefficient Medicare Part D Appeals Process Can Result in Dangerous Medication Delays

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    • #79229
      • Total Posts: 7,444


      The Medicare Rights Center applauds Senators Ben Cardin (D-MD) and John Cornyn (R-TX) for introducing the bipartisan Streamlining Part D Appeals Process Act (S. 1861).

      The bill would eliminate unnecessary steps in the Medicare Part D appeals process, making the system less burdensome for people with Medicare, providers, and plans. Specifically, the Cardin-Cornyn bill would simplify the process for Part D enrollees who experience medication denials at the pharmacy counter.

      Currently, when beneficiaries are told at the pharmacy counter that their Part D plan will not cover a prescription, they must then work with their prescribing physician to file an exception request with the plan. Only upon receipt of a written denial in response to this request—called a “coverage determination”—may the beneficiary request a formal appeal from the plan.

      This multi-step process is overly onerous for all involved. It requires people with Medicare to correspond with both their plan and their prescriber on multiple occasions, which may involve many phone calls and long wait times, often up to several days. For many older adults and people with disabilities, this is dangerously too long to go without needed medication.

      Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction

    • #234910
      • Total Posts: 286

      Part D has been a scam put on us so both pharma and insurance industry can get rich.

      Heavy regulation is in order. As of now they police themselves with no oversight.

      "Violence is the last refuge of the incompetent." - Asimov; "If you push something hard enough, it will fall over." - Fud's First Law of Opposition

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