tci Medicare Compliance & Reimbursement - 2007 Issue 34

PART D: Tap These 5 Truths To Help Patients Win Coverage

Keep education in mind to counter off-label denialsAll too often, patients' myths and misconceptions about Part D leave them dangling with no coverage for a drug their doctor has prescribed--and leave you with an ethical dilemma. Help them back to solid ground with some quick coaching on their rights regarding exceptions and appeals.1. Clients should contact their prescription drug plans (PDP) to seek an exception in two instances:• If a needed medication is not on the PDP's formulary, find out if the drug has been dropped from the formulary for reasons other than safety. If so, a...

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