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Require Part D plans to give the reason for a medication denial at the pharmacy counter

Knowing why a prescription drug is refused at the pharmacy counter is critical to helping beneficiaries determine their next steps—whether it is working with their physician to secure […]

Require Part D coverage determinations at the pharmacy counter

After being refused a prescribed medication at the pharmacy, a beneficiary must formally request coverage from their Part D plan before the appeals process can even begin. In […]

May 18th, 2015|Categories: 50 Medicare Wishes, Simplify Appeals, Strengthen Part D|

Allow appeals on the Part D specialty tier

When medically necessary, people with Part D have the right to request that their plan allow them to pay less for high-cost medications when a similar, lower-cost medicine […]

Add Part D to an integrated appeals process for Medicare-Medicaid managed care plans

In some states that are testing new care coordination models for dually eligible Medicare and Medicaid beneficiaries, the federal government is allowing the state and health plan to […]

May 16th, 2015|Categories: 50 Medicare Wishes, Simplify Appeals, Strengthen Part D|

Improve Medicare Advantage (MA) and Part D denial notices

The most common call to the Medicare Rights national helpline comes from a beneficiary denied access to a health care service or prescription medication, and most of these […]

May 7th, 2015|Categories: 50 Medicare Wishes, Enhance Education and Choice, Simplify Appeals|

Create an appeals process for beneficiaries in hospice care

Currently, beneficiaries receiving Medicare-covered hospice care do not have any recourse if they disagree with a determination made by their hospice provider, like the determination that a particular […]

April 27th, 2015|Categories: 50 Medicare Wishes, Simplify Appeals|