Streamlining Part D Appeals Process Act

Streamlining Part D Appeals Process Act

This bill allows a Medicare beneficiary to directly appeal a pharmacy's refusal to fill a prescription as a coverage determination under the Medicare prescription drug benefit.

Currently, if a pharmacy refuses to fill a prescription, the pharmacy provides the beneficiary with a notice explaining how to contact the beneficiary's prescription drug plan (PDP); the beneficiary must then obtain a written coverage determination (i.e., a decision denying coverage) from the PDP before initiating the appeals process.