Statement by Medicare Rights Center President Joe Baker on Proposed Changes to Medicare Advantage and Part D Appeals
New York, NY—This week, the Centers for Medicare & Medicaid Services (CMS) took positive steps towards addressing long-standing issues with the Medicare Advantage (MA) and Part D appeals system. The advance notice of the 2016 call letter for changes to MA and Part D proposes to simplify the appeals process by improving notices sent to people with Medicare. Importantly, the draft call letter clarifies the expectation that plans seek medical information from a prescriber to support a prescription drug request. We expect this updated policy will reduce burdens on beneficiaries to get or produce such information and help ensure uninterrupted access to needed medicines.
We applaud CMS for taking seriously the results of recent audits showing deficits in denial notices and for taking concrete steps, in line with the Medicare Rights Center’s suggestions, to improve those essential documents. We also thank CMS for addressing our concerns about the lack of personalized, actionable information pertaining to denials of coverage for prescriptions, or other clinical or benefit changes at the pharmacy counter.
We are encouraged by these improvements and look forward to working with our partners and CMS to streamline the appeals process for beneficiaries and to reduce known barriers to accessing needed health care services and prescription drugs.