Take action to reform the Part D denial and appeal process

Take ActionEvery year, the Medicare Rights Center helps thousands of individuals navigate the complicated Medicare Part D appeals process. Because the process is the equivalent of a nonsensical maze, it leaves beneficiaries confused, frustrated, and unable to adhere to prescribed treatment plans.

Join the Medicare Rights Center in calling on the Center for Medicare and Medicaid Services (CMS) to immediately implement reforms to help people with Medicare better navigate Part D denials and appeals.

The most recent audit conducted by CMS of Part D and Medicare Advantage (MA) plan sponsors showed that:

  • 89% issued denial letters to beneficiaries that either failed to include an adequate rationale or contained incorrect information
  • 78% failed to demonstrate sufficient outreach to obtain additional information necessary to make an appropriate clinical decision
  • 56% made inappropriate denials when processing coverage determinations
  • 61% were shown to apply unapproved quantity limits
  • 50% were shown to apply unapproved utilization management practices