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Congress Must Streamline the Medicare Part D Prescription Drug Appeals Process

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The Medicare Part D appeals process is an essential safety valve that allows older adults and people with disabilities to access and afford needed prescriptions. However, complexities in the current system can make it difficult for beneficiaries to obtain the relief they need.

On Medicare Rights’ National Consumer Helpline, we frequently hear from Part D enrollees who are struggling with appeals and coverage-related issues. Many of these callers were told at the pharmacy counter that their plan would not cover their medication—but not the reason why. Medicare puts the onus on these enrollees to investigate the reason for the denial and to figure out what to do with that information.

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