WHO can Challenge a Non-Covered Medication Charge?

The beneficiary or an appointed representative may request an appeal. This person may be a relative, friend, advocate, doctor or someone else who is allowed to act for the member. Each State may have special laws that allow others to act in this capacity.

To name someone as an appointed representative, the member may either:

• Complete a CMS Appointment of Representative (AOR) form (CMS-1696) here
• Or the member may call their Medicare drug plan directly for instructions