Question 1

What's the difference between a pharmacy notice and a denial notice?

Accepted Answer

A pharmacy notice ("Medicare Prescription Drug Coverage and Your Rights," form CMS-10147) isn't itself a denial you can appeal — it's a hand-out the pharmacy gives you when it can't fill a prescription, telling you to contact your plan. The plan's own written denial ("Notice of Denial of Medicare Prescription Drug Coverage," form CMS-10146) is the actual appealable decision, and it's what starts your 65-day clock.

Question 2

What's a coverage determination, and how is it different from an appeal?

Accepted Answer

A coverage determination is your very first request to the plan — asking it to cover a specific drug, or to grant an exception (a formulary, tiering, or utilization-management exception). If the plan denies that request, THEN you have the right to appeal (a redetermination). There's no deadline to make the first request — the 65-day clock only starts once you're denied.

Question 3

Why does the prescriber's supporting statement matter so much?

Accepted Answer

For most exception requests, the plan's own clock to decide doesn't start until it receives your prescriber's written supporting statement — and if 14 days pass with no statement, the plan can decide (usually unfavorably) without one. Getting the supporting statement in fast is often the single most important step in a Part D appeal.

Question 4

Why does my drug plan's own clock run in hours instead of days?

Accepted Answer

A Part D coverage determination or redetermination is decided fast on purpose — 72 hours standard, 24 hours if expedited (7 days / 72 hours at the redetermination level). Your own deadline to file stays day-scale (65 days), but the plan's is hour-scale, which is why CaseWhy Appeals tracks both clocks separately and sends reminders at the hour, not just the day.

Question 5

What does Appeals Plus cost for a Medicare Part D case?

Accepted Answer

$39, one time, per case — covering every appeal level for 12 months, including any later letter the case needs as it advances (a redetermination request, an IRE reconsideration request, and so on). It's not a subscription; nothing renews or recurs.

Question 6

Does CaseWhy Appeals show ads or sell my data?

Accepted Answer

No, and never will. CaseWhy Appeals has no ads, no ad network, and no third-party trackers of any kind. We don't sell or rent your information to anyone.

Question 7

Is the specific drug's name stored anywhere?

Accepted Answer

No. CaseWhy Appeals keeps only a coarse denial-reason category (for example, "not on the formulary" or "prior authorization") — never the drug's brand or generic name. You enter the drug name only at the moment you download a form or letter that needs it, the same way you enter your Medicare number, and it isn't stored.

Your Medicare Part D plan denied a prescription. Here's what to do next.