The pharmacy or the plan said no, and you can't wait. Here's what to do right now.

Call the number on your plan card, your prescriber's office, or the pharmacy's own rejection notice — Part D has no separate hotline the way a hospital discharge does. Pick your situation below for the exact clock and what to say.

The pharmacy can't fill it and you can't wait

The plan must decide within 24 hours of an expedited coverage-determination request. A prescriber's request for expedited review must be honored.

42 CFR 423.57042 CFR 423.572

What to say

  1. Ask the pharmacist to call the plan's member services line directly — the number is on your plan card or the pharmacy's own rejection notice.
  2. Say your prescriber wants this request expedited, and ask that a coverage determination be made within 24 hours.
  3. Ask about a one-time temporary transition supply while the request is pending, if you're a new enrollee or the plan's formulary just changed.

Next: This is a Level 0 coverage-determination request. See what the request needs to say →

The plan said no and you can't wait

The plan must decide an expedited redetermination within 72 hours of the request. A prescriber's request for expedited review must be honored.

42 CFR 423.58442 CFR 423.590

What to say

  1. Call the number on the plan's written denial (the coverage determination notice, CMS-10146) and ask for an expedited redetermination.
  2. Say your prescriber wants this request expedited, and ask that a decision be made within 72 hours.
  3. You have 65 days to file this from the date of the denial notice — but expedited review only helps if asked for now, before that clock matters.

Next: This is a Level 1 redetermination request — the letter CaseWhy Appeals drafts once your case explains this notice.

You need a drug that isn't on the list

For an exception request, the plan's clock doesn't start until it receives your prescriber's written supporting statement — then 24 hours if expedited, 72 hours standard. If the plan never receives a statement, it can decide (usually unfavorably) after 14 days.

42 CFR 423.57842 CFR 423.570

What to say

  1. Ask your prescriber's office today for a written supporting statement explaining why the covered alternatives wouldn't work for you — the clock doesn't start without it.
  2. Ask that the statement say the standard timeframe could seriously jeopardize your health, if that's true, so the plan must expedite.
  3. Ask the pharmacy about a temporary transition supply while the exception is decided, if you're a new enrollee or this is a mid-year formulary change.

Next: This is also a Level 0 request — a formulary or tiering exception, not a coverage determination, but the same starting point.

Not urgent — the plan already sent a written denial and it isn't life-or-health emergency?

That's the standard 65-day redetermination, not this page. Start there instead →

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