Federal programs / Medicare Part D (drug coverage)
Medicare Part D (drug coverage)
A coverage determination first (including exceptions, which need the prescriber's supporting statement), then a redetermination by the plan, then the Independent Review Entity.
| Form | Use it to | Deadline | Issued by |
|---|---|---|---|
| Redetermination request (model form and process) | Ask the plan to reconsider a coverage determination | 65 days from the date on the notice (42 CFR 423.582) | CMS |
| Prescription drug appeals and grievances (overview) | Every Part D appeal level and model notice | See the notice | CMS |
| CMS-1696, Appointment of Representative | Let someone act for you | With the appeal | CMS |
Where it goes
The plan's appeals address or fax on the denial notice; the prescriber can request an expedited exception by phone.
The rule
42 CFR Part 423, Subpart M; exceptions under 42 CFR 423.578. Links verified 2026-09-15; the notice you received controls over anything here.
Want the appeal itself written to the criteria, with the rule cited? Apellica's generator is free; a reviewer can also read the denial first.