A Medicare Part D coverage determination is a decision by your Part D plan about whether to cover a drug, how much you will pay, or whether an exception applies. You can request a coverage determination if your plan denies coverage for a drug. If you disagree with the decision, you can appeal.
Key Points
- Coverage determination: plan decision about drug coverage
- Request a coverage determination if your plan denies coverage
- Plan must respond within 72 hours (24 hours for urgent requests)
- If you disagree: you can appeal the decision
- An independent agent can help you navigate coverage determinations