Medicare Drug Coverage:
Exceptions and Appeals
Background Information
FAQ
Training Materials
Conference Calls
HAP Resources
- Exceptions Process Flowchart
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Pharma-Gram A brief "takeaway" for beneficiaries to pick up at the pharmacy counter if they are having trouble getting their prescriptions filled. Provides specific action steps.
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Quick Guide to Exceptions for Consumers This handout may be used in the pharmacy to educate consumers about what they can do if their drugs are not covered by their Part D plans. It also provides a brief overview of the steps to request a formulary exception and, if necessary, file an appeal.
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Part D Appeals Guide This tool provides beneficiaries and advocates with information on the reasons why a Part D Plan may refuse to cover a prescribed drug, as well as step-by-step instructions on how to file an exception or an appeal.
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CMS Resources
CMS Updates
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Formulary Denial Intake Form This form allows advocates to monitor and track each step of the exceptions and appeals process for their clients.
March 15, 2006: Moving Beyond the Theory of Exceptions and Appeals
February 22, 2006: More Solutions
