Some Medicare Part D Beneficiaries Face Avoidable Extra Steps That Can Delay or Prevent Access to Prescribed Drugs

This evaluation examines data and oversight related to Part D pharmacy rejections and coverage denials that, when issued for avoidable or inappropriate reasons, can lead to delays in beneficiary access to needed drugs. Part D is an optional benefit that helps beneficiaries pay for medically necessary prescription drugs. However, Part D's shared-risk payment model can create an incentive for sponsors to deny requests for prescription drugs in an attempt to increase profits. Because Part D covers more than 45 million beneficiaries, even low rates of denied or delayed medically necessary drugs or reimbursement could contribute to physical or financial harm for Medicare beneficiaries.