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Case Study: Streamlining Part D Appeals Process Act

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Reforms to the Part D appeals process are long overdue, a need made ever-more urgent by a growing Medicare-eligible population, the increased use of utilization management strategies by plans, and ongoing efforts to tackle high and rising prescription drug prices—all of which could push more beneficiaries into this broken system.

Forcing additional consumers to work through this process would only exacerbate and amplify its failures, to the detriment of people with Medicare. We urge policymakers to address systemic inefficiencies within the Part D appeals process—namely the lack of information provided to beneficiaries at the time of a pharmacy counter denial and the subsequent requirement that a beneficiary obtain a separate coverage determination— without delay, by enacting S. 1861/H.R. 3924.

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