Medicare Prescription Drug Coverage & Your Rights

Various prescription drugs covered by Medicare

According to the 2003 Medicare Prescription Drug, Improvement and Accountability Act, patients who encounter problems with prescription drug benefits are eligible for a number of personal benefits. This was not the case with the previous Medicare program, which denied coverage of drugs to many beneficiaries.

Identification

Medicare Part D mandates that every pharmacy in the program's network provide beneficiaries with form CMS-10147. This form outlines the exact parameters of the Medicare Part D law for patients.

Function

According to Medicare Part D, you have the right to appeal a decision from a private health care provider when they choose not to cover a prescribed medicine. This is the same regardless of whether you use Medicare proper or a Medicare HMO or PPO.

Considerations

Each private Medicare drug coverage plan is required to maintain a specific department with its own phone number for the appeals process. This is designed to help streamline your appeal case.

Features

Unlike previous Medicare plans, Part D allows you to use an outside advocate to work on your behalf. However, you must first appeal to the private plan before making an appeal directly to Medicare.

Significance

According to the Centers for Medicaid and Medicare Services, each prescription drug plan must have a formulary available to its members. This is a list of the drugs covered by the plan.

References

• Medicare Part D Appeals Manual
• Form Instructions "Medicare Prescription Drug Coverage and Your Rights"
• Barriers to Care in the Part D Appeals Process

Resources

• Medicare Prescription Drug Coverage