Coverage Determination (Part D) | Medicare Glossary

The initial decision made by your Medicare drug plan (not the pharmacy) about you prescription drug benefits. This includes:

• whether a particular drug is covered

• how much you are required to pay for a drug

• whether you have met all requirements for obtaining a requested drug

You must call or write your plan to make an exception. The Medicare drug plan must make a decision in a timely manner (72 hours for standard requests, 24 hours for expedited requests).