Timeline for Medicare Part D AppealsQuestion 5 of 5 (use "Last" or "Next" buttons to see more) Last Update: October 24, 2007
Formulary Exception Request
- Medicare private drug plan must decide within 72 hours of receiving your doctor's statement explaining why the drug is medically necessary for you (24 hours if it is an expedited appeal).
Plan Redetermination (Appeal)
- You must request appeal within 60 days of receiving denial.
- Medicare private drug plan has 7 days to make a decision (72 hours if it is an expedited appeal).
- Amount in question does not matter.
Reconsideration (Review by an Independent Review Entity)
- You must request appeal within 60 days of receiving denial.
- IRE has 7 days to make a decision (72 hours if it is an expedited appeal).
- Amount in question does not matter.
Administrative Law Judge (ALJ) Hearing
- You must request appeal within 60 days.
- Amount in question must be at least $140 in 2013.
- 90 day time limit within which to respond.
Medicare Appeals Council (MAC) Hearing
- You must request appeal within 60 days.
- Amount in question does not matter.
- 90 day time limit within which to respond..
Judicial Review (Federal District Court)
- You must request appeal within 60 days.
- Amount in question must be at least $1,400 in 2013.
- No time limit within which to respond.
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