Reform Medicare Appeals for Part D

The most troublesome part of Medicare is the prescription drug program, or Part D, used by 24 million Americans.

First of all, drugs are expensive. Secondly, insurers don’t always cover what you need. And fighting to get what will help you is often time-consuming, frustrating and can ultimately be detrimental to your health. It’s time to reform the Medicare Appeals process for Part D.

In addition, a General Accounting Office (GAO) report in January found that a quarter of all drug plans contained inaccurate information and as a result weren’t included in the online plan finder of the Centers for Medicare and Medicaid Services (CMS).

Obviously, there’s a problem.

The Medicare Rights Center is pressing Congress to take meaningful action to reform the appeals process and we think this is extremely important.

Medicare Rights Center President Joe Baker says, “The Part D appeals system is in desperate need of repair.  The current Part D appeals process is bogged down by needless steps that translate into delayed access to medications for beneficiaries, threatening their health and well-being and putting them at greater risk for ambulance rides, emergency room visits and hospital stays.”

Baker applauds, and so do we, a letter written by Senator Bill Nelson(D-Fla.) and Senator Susan Collins (R- ME) with U.S. Reps. Hank Johnson (D-GA), Jan Schakowsky (D-IL), David McKinley (R-WV) and Keith Ellison (D-MN) to CMS administrator Marilyn Tavenner calling for reform of the appeals process and a review of the way expensive medication is treated under Part D.

The current system sets a limit of $600 and that’s unrealistic for some life-saving medications. The letter calls on CMS to reform not only the appeals process but update the cost sharing program for prescription medication.

This is an important issue that requires our attention. If you have something to say, comment and keep this discussion going to create meaningful change.







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Barbara Nevins Taylor

As the winner of 22 Emmy Awards and a slew of journalism honors and awards, I created to give you the straight story about complicated stuff. Tell us what you want to know and we'll get you the answers.