Medicare Rights Center Supports Legislation to Streamline the Medicare Part D Prescription Drug Appeals Process, States Medicare Rights President Fred Riccardi
— Current Process is Confusing and Burdensome, Creating Barriers to Access and Affordability of Medications for People with Medicare —
Washington, DC—The Medicare Rights Center applauds Rep. Tom Suozzi (D-NY) and Rep. Tom Reed (R-NY) for introducing the bipartisan Streamlining Part D Appeals Process Act (H.R. 3924).
This legislation, which Medicare Rights strongly supports, would bring much-needed efficiencies into the Medicare Part D appeals process, making the system less burdensome for beneficiaries, providers, pharmacists, and plans.
On our National Consumer Helpline, we frequently hear from older adults and people with disabilities who are struggling to understand this complex appeals process, and who are facing significant access and affordability issues as a result.
Many of these calls are from Part D enrollees who were told at the pharmacy counter that their plan would not cover their prescription—but not the reason why. They often leave the pharmacy empty-handed and unsure what to do next.
This confusion is understandable, as Medicare rules place the onus solely on these beneficiaries to investigate the reason for the prescription drug refusal and to chart a path forward—which can take several days, require multiple phone calls to their plan and to their provider, as well as create administrative hardships for all involved.
For many older adults and people with disabilities, these inefficiencies can lead to delays in accessing needed prescriptions, abandonment of medications, reduced adherence to treatment protocols, worse health outcomes, and higher costs.
H.R. 3924 would directly address these challenges by allowing a pharmacy counter denial to serve as the plan’s initial coverage determination. This one change would solve multiple problems. It would give people with Medicare more timely access to information about their plan’s coverage decision, allowing them to more expeditiously reach a resolution, while also eliminating unnecessary steps in the process for beneficiaries, plans, and prescribers.
These sensible reforms are long overdue. We thank Congressmen Suozzi and Reed for their leadership and urge lawmakers to pass this bill without delay.
The Medicare Rights Center also thanks Senators Ben Cardin (D-MD) and John Cornyn (R-TX) for championing the Streamlining Part D Appeals Process Act (S. 1861) in the Senate.
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