Statement by Medicare Rights Center President Joe Baker on Planned Improvements to Medicare Part D Appeals

New York, NY—With this week’s release of the final 2016 Medicare Advantage and Part D call letter, the Centers for Medicare & Medicaid Services (CMS) confirmed its commitment to strengthening the Medicare Part D appeals process through improved denial notices, a new pilot program focused on beneficiary access at the point-of-sale, and enhanced data collection.

We applaud CMS for heeding calls from consumer advocates, pharmacists, case managers, and others to build a better Part D appeals process. The intiatives announced by CMS in the final call letter matter to every Medicare beneficiary who has experienced an unnecessary delay in securing needed medications or who has simply gone without. Making the Part D appeals process easier to navigate is critical to elevating the customer service of private health plans and advancing the health and well-being of seniors and people with disabilities.

We are particularly pleased with CMS’ decision to move forward with a pilot program to test ways to improve the beneficiary experience when access to a medication is refused at the pharmacy counter. Ensuring that beneficiary advocates are involved in the development and implementation of this pilot initiative, alongside plans and pharmacy benefit managers oddstake, will be critically important. Similarly, we are grateful for CMS’ commitment to engaging a broad range of stakeholders on the development of improved guidance for health plans on beneficiary denial notices and on the creation of model language for these notices to more clearly explain why prescription drug coverage is being denied.

Click here to view comments from 20+ organizations on the draft 2016 Part C and Part D call letter.

Contact: Mitchell Clark, Senior Communications Associate, mclark@medicarerights.org, 212-204-6286

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