The Medicare Part D appeals process is an essential safety valve that allows older adults and people with disabilities to access and afford needed prescriptions. However, complexities in the current system can make it difficult for beneficiaries to obtain the relief they need.

Urge your lawmakers to strengthen the Part D appeals process.

On our National Consumer Helpline, we frequently hear from people with Medicare who are struggling to navigate the Part D appeals process, and who are facing significant barriers to care as a result. The Streamlining Part D Appeals Process Act (S. 1861/H.R. 3924) is a bipartisan policy fix that would simplify this system, making it less burdensome for all involved.  

Send a letter today asking your members of Congress to support the Streamlining Part D Appeals Process Act.

The Streamlining Part D Appeals Process Act would allow a refusal at the pharmacy counter to function as the health plan’s initial coverage determination. This important change would:

• Trigger the provision of a detailed, formal denial notice at the point-of-sale, giving people with Medicare more timely access to actionable information about their plan’s coverage decision; and
• Eliminate unnecessary steps within the current system—including the need for beneficiaries to request pre-denial information and counsel from their plans and providers—thereby empowering beneficiaries to more expeditiously exercise their appeal rights and obtain an independent review.

These much-needed improvements would help ensure that current and future Medicare beneficiaries can better understand and manage the Part D appeals process.

For more on the bill and who it would help, see Medicare Rights’ one pager and case study.