After being refused a prescribed medication at the pharmacy, a beneficiary must formally request coverage from their Part D plan before the appeals process can even begin. In other words, a beneficiary must ask for a denial that she can then appeal. Being told no at the pharmacy doesn’t count as a formal denial. To ease beneficiary burdens and streamline the appeals process, the federal government should require Part D plans to make some types of coverage determinations at the pharmacy counter—eliminating a needless step in the appeals process for Medicare beneficiaries.
Require Part D coverage determinations at the pharmacy counterMedicare Rights Center