Sep 6, 2023 · A coverage determination is any decision made by the Part D plan sponsor regarding: Receipt of, or payment for, a prescription drug that an ...

Apr 30, 2024 · This page discusses the enrollees right to request a Part D coverage determination, appeal or file a grievance/complaint.

Grievances · Coverage Determinations · Exceptions · Forms

Sep 6, 2023 · Forms applicable to Part D grievances, coverage determinations and exceptions, and appeals processes.

Dismissal: A decision not to review a request for a grievance, initial determination, or appeal because it is considered invalid or does not otherwise meet ...

Sep 6, 2023 · The grievance involves a refusal by the Part D plan sponsor to grant an enrollee's request for an expedited coverage determination or expedited ...

An appeal is any of the procedures which deal with the review of adverse coverage determinations made by the Part D plan sponsor on the benefits under the Part ...

Sep 6, 2023 · For more information regarding grievances and various levels of appeal, please see the links on the left navigation menu on this page.

Grievances · Organization Determinations · Notices and Forms · Training