Ask the plan directly
A fast level 1 Part D appeal is called an expedited redetermination. Use the telephone number or other expedited channel in the plan's denial notice, Evidence of Coverage, or membership materials. Expedited requests may be made orally or in writing.
Prescriber support can determine the result
If you make the request, the plan decides whether the standard 7-day timeframe may seriously jeopardize your life, health, or ability to regain maximum function. If the prescribing physician or other prescriber states that the standard timeframe creates that risk, federal rules require the plan to expedite the redetermination.
The 72-hour clock is for the appeal decision
When expedited handling is accepted, the plan must decide the redetermination as quickly as your health requires and no later than 72 hours after receiving the request. This differs from an expedited initial coverage determination, which generally has a 24-hour limit.
A payment dispute is not expedited
The expedited process applies to a drug benefit you have not yet received. A request to be reimbursed for a drug already furnished follows the standard payment process.
If the plan refuses expedited handling
The plan must process the appeal under the standard timeframe, tell you about the right to file an expedited grievance, and explain that you may submit another expedited request with prescriber support. Keep the time, date, representative's name, and confirmation number for each contact.
An appeal is an administrative coverage process, not emergency care. Use emergency medical services when immediate care is needed, and contact the prescriber and plan as soon as practical.
Official sources
- Medicare.gov — fast Part D appeals
- CMS — Part D redetermination timeframes
- eCFR — expedited redetermination rules