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Case Study: Streamlining Part D Appeals Process Act

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.

Policy Issues: Denials and Appeals
Protect & Strengthen Medicare

Any changes to the Medicare program must aim for healthier people, better care, and smarter spending—not paying more for less. As policymakers debate the future of health care, we will provide our insights here.

30 Policy Goals

Thinking ahead to Medicare's future, it’s important to modernize benefits and pursue changes that improve how people with Medicare navigate their coverage on a daily basis. Here are our evolving 30 policy goals for Medicare’s future.

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