Dear Bernadette, 

Not being able to access your medication can be very stressful. There are a few steps you can take to identify the issue and to ensure you have uninterrupted access to your medication going forward: 

• Know your coverage: 
  • Call your plan and check if there are any applicable coverage restrictions. These are rules you must follow before your plan covers your drug. 
  • Call Medicare to learn about which part of Medicare should cover your drug.  
  • Check to make sure your Part D drugs are on your plan’s formulary, or list of covered drugs.  
• Make sure your pharmacist submits claims properly: 
  • Your pharmacist could be billing your prescription to the wrong part of Medicare or without required documentation. This could explain a drug coverage denial or why your pharmacist is having trouble with your plan.  
    • If your provider doesn’t know how to submit these claims, they can reach out to your plan or to Medicare for help.  
• Make sure your provider or pharmacist has the documentation they need: 
  • This is helpful for drugs that are covered differently depending on the situation.  
    • For example: If Part B should cover your insulin because you use an infusion pump to take it, you may need to show proof that you have a pump. 
• Know your right to appeal:  
  • You have the right to appeal Medicare’s or your plan’s denial 
  • Ask your doctor to help prove your drug is medically necessary and that you meet the coverage criteria. 

Hope this helps!