CMS Aims to Improve the Medicare Part D Appeals Process

Earlier this year, the Centers for Medicare & Medicaid Services (CMS) released a proposal to improve the Part D appeals process and is considering making further changes to this process in the future.

In case you didn’t know, the Medicare Part D appeals process allows patients like you to challenge your plan’s prescription coverage decisions and, if successful, gain access to needed medications. Currently, the appeals system is complicated and often difficult for patients to navigate. The inability to easily appeal a coverage decision could mean you simply stop taking your medications which could in turn harm your health.

Fortunately, the Administration’s proposal could rectify some of the challenges that seniors face when accessing the appeals system. In an opinion piece on The Hill’s Congress Blog, Tom Baker, president of the Medicare Rights Center, outlined the important changes being suggested and the questions being considered by CMS:

“To address these problematic trends, CMS suggests additional requirements to strengthen denial notices and to improve communication between the plan and the prescriber when coverage for a prescription drug is denied. These policies will ease patient burdens and improve access to needed medicines. CMS also seeks input on how to expand on these changes, asking a series of important questions: Is it possible to give patients information on the reason for a denial at the pharmacy counter? Is it possible to reduce the number of steps a beneficiary must take to request coverage? Is it possible to collect better data on the beneficiary experience at each stage of an appeal? … We applaud CMS for asking the right questions, and we encourage the agency to move forward with reforms to help Medicare beneficiaries better navigate Part D denials and appeals.”

The full article is definitely worth a read, so make sure to check it out. And reach out to CMS on social media @CMSGov to let them know you appreciate the changes they are considering to make accessing the medications you need easier in the future.