Medicare Prescription Drug Coverage & Your Rights

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.