WHAT SHOULD I DO IF I AM HAVING TROUBLE ACCESSING MY MEDICATION ON MY MEDICARE PLAN?
Know how your medication is covered. Call 1-800-MEDICARE to find out whether your drug should be covered by Part A, B, or D.
Ask your pharmacist or provider to submit claims to the correct part of Medicare. If your pharmacist is having trouble billing Medicare/your Part D plan, or if you are being denied coverage for a drug, it is possible that the medication is being billed incorrectly. If your provider is unsure of how to submit these claims, tell them they can reach out to your plan or Medicare for assistance.
If this is a Part D-covered drug, they should call your Part D plan.
If this is a Part B-covered drug and you have a Medicare Advantage Plan, they should call your Medicare Advantage Plan.
If this is a Part B-covered drug and you have Original Medicare, they should reach out to the Medicare Administrative Contractor for your region.
If payment is denied, appeal the denial. You have a right to appeal Medicare’s or your plan’s denial. Ask your doctor to help you prove that the medication is medically necessary for you and that you meet the coverage criteria. If you need help appealing a denial of coverage, contact your State Health Insurance Assistance Program (SHIP), by calling 877-839-2675 or visiting shiptacenter.org.