If you were denied coverage for a prescription drug, you should ask your plan to reconsider its decision by filing an appeal. Your appeal process will be the same whether you have a stand-alone Part D prescription drug plan or a Medicare Advantage plan that includes your Part D prescription drug coverage.
If your pharmacist tells you that your plan will not pay for your prescription drug, you should call your plan to find out the reason it is not covering your drug. Then, you should talk to your prescribing physician about your options. If switching to another drug is not an option, you should file an exception request – a formal coverage request – with your plan. Call your plan to learn how to file an exception request. Make sure you get a letter of support from your doctor and include that with your request.
Your plan should issue a decision within 72 hours. File an expedited request if you need your drug right away, and your plan should issue a decision within 24 hours. If your request is approved, your drug will be covered. If it is denied, you should follow the directions on the written denial you receive to appeal.