MedicareDenied Your Medication? Here's How to Fight Back

About Medicare

Traditional Medicare (Parts A & B) has specific PA appeal rights governed by CMS. You have 5 levels of appeal: redetermination, reconsideration by a QIC, ALJ hearing, Medicare Appeals Council, and federal court. Part D drug denials go through your Part D plan's process.

Commonly Denied Medications

These are among the most frequently denied medications across all insurers. If Medicaredenied one of these, you're not alone — and there are proven appeal strategies.

How to Appeal a Medicare Denial

1. 1

   Get the denial in writing

   Request the specific clinical criteria and reviewer credentials.

2. 2

   Ask your doctor for a peer-to-peer review

   A direct call between your doctor and Medicare's medical director often resolves denials quickly.

3. 3

   File an internal appeal

   Include a letter of medical necessity, clinical evidence, and your treatment history.

4. 4

   Request an external review if needed

   An independent reviewer examines your case. Their decision is binding on Medicare.