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Free Senior Citizens Help with Understanding Medicare Prescription Drug Coverage, Medicare Part D
| What if my plan won’t cover a drug I need? |
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| Medicare Prescription Drug Coverage - How to File a Grievance or Appeal |
If your pharmacist tells you that your Medicare drug plan won’t cover a drug you think should be covered, or it will cover the drug at a higher cost than you think you are required to pay, you have the right to the following:
You, your doctor, or your appointed representative can call your plan or write them a letter to request that the plan cover the prescription you need. You can write a letter or you can use a form called the “Model Coverage Determination Request” form to request a coverage determination from your plan. You may file either a standard request or an expedited request for your coverage decision. Your request will be expedited if your plan determines, or your doctor tells your plan, that your life or health may be seriously jeopardized by waiting for a standard request. Once your plan has received the request, it has 72 hours (for a standard request for coverage or for a request to pay you back) or 24 hours (for an expedited request for coverage) to notify you of its decision. |
