Medicare Rights Releases Report on How to Improve Access to Medication under Medicare Part D

Today, the Medicare Rights Center released a report on how to streamline the Medicare Part D appeals process for older adults and people with disabilities. The report, Medicare Facts and Faces: Refused at the Pharmacy Counter—How to Improve Medicare Part D Appeals, examines challenges faced by Medicare beneficiaries refused prescribed medications at the pharmacy counter and offers the following key recommendations:

• Add individually tailored language to the standard appeal notice that pharmacies will soon be required to deliver. In addition to the plan contact information, including phone and online access, and clear guidance on the next steps in the appeals process, the denial notice should include a clear explanation of the reason a drug is denied coverage.
   
• Initiate the appeal at the pharmacy counter. The Centers for Medicare & Medicaid Services (CMS) should explicitly require Medicare Part D plans to treat the point-of-sale refusal as the initial coverage determination, at which time the beneficiary has the option to automatically initiate the appeals process.

Each year, the Medicare Rights Center receives thousands of calls from people with Medicare, their caregivers and service providers looking for help with Medicare appeals and coverage issues. In most cases, a beneficiary first learns that they will have difficulty obtaining their medication when they attempt to fill a prescription and are refused at the pharmacy counter. From there, the responsibility falls entirely on the beneficiary to determine how to obtain needed medication. The current process can delay a beneficiary’s access to needed medications, if they are able to access the medication at all. As noted in the report, beneficiaries must be equipped with the right information at the right time and minimize the steps required to appeal a plan’s denial.