Your Medicare Part D Rights Notice – New as of July 1, 2012
Beginning today, July 1, 2012, if you have the Medicare prescription drug benefit, Part D, and for some reason your pharmacist tells you that your Part D will not cover your prescription, your pharmacy must give you a special notice. It must give you this notice whether you have your Part D coverage with a stand-alone Part D plan, or with your Medicare Advantage plan. This notice, which may or may not have your pharmacy’s logo at the top, will always have the following heading in bold near the top:
Medicare Prescription Drug Coverage and Your Rights
The purpose of this notice is make sure that you know your rights when your drug plan decides that for some reason it believes that your prescription is not covered. And it must be given to you at the “point-of-purchase,” that is, at the pharmacy, which is likely where you will first find out you have a problem.
More specifically, it tells you that you have the right to a “coverage determination,” that is, a more formal notice from you plan telling you exactly why it won’t pay for your prescription, and that you even have the right to make an “exception request,” which you can do if the plan is initially properly denying your prescription.
If you get this notice you should first contact your drug plan; their toll-free number is on the back of your membership card. It’s possible that some clerical error or procedural mistake has occurred, and can be quickly corrected. If not, your plan has to give you a written coverage determination, and tell you how to appeal it. All the information you need to do this is in Managing Your Medicare, beginning on page 206. And you can always call 1-800-MEDICARE, or contact a counselor in your State Health Insurance Program (or SHIP, their number is on the back of your Medicare & You booklet) for more help and guidance. You will need assistance from your physician or prescriber to get an exception.
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