tci Part B Insider - 2007 Issue 35

Part D Or Part B? Know Who's Covering Chemotherapy Drugs

Beneficiaries must continue to jump through Part D's administrative appeals hoops when prescription drug plans deny coverage of needed drugs.A cancer patient who claims that her Medicare Advantage plan improperly classified her chemotherapy drugs must first exhaust her administrative remedies under Medicare before she can seek judicial review of her claims. That decision was handed down last month from a federal district court in Florida (Masey v. Humana Inc., M.D. Fla. No. 06-1713).In cases in which a party's claims are -inextricably intertwined- with a claim for Medicare benefits, judicial review is not available until the party...

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