50 Wishes for
Medicare’s Future

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Wish #25:
Add Part D to an integrated appeals process for Medicare-Medicaid managed care plans

In some states that are testing new care coordination models for dually eligible Medicare and Medicaid beneficiaries, the federal government is allowing the state and health plan to use an integrated appeals process. These innovative appeals models combine the best of the Medicare and Medicaid systems. But, this process is missing a critical element—prescription drug denials and appeals. The federal government should integrate Part D appeals as it continues to test how best to integrate care for those with Medicare and Medicaid coverage.