If your Medicare drug plan decides against you in level 1, it will send you a written decision. If you disagree with the decision, you can request a standard or fast reconsideration by an Independent Review Entity (IRE). Your representative, doctor, or other prescriber can also request a reconsideration for you.
You can’t request a fast redetermination if it’s an appeal about payment for a drug you already got. Follow the directions in the plan’s "Redetermination Notice." If your plan issues an unfavorable redetermination, it should also send you a "Request for Reconsideration" form. You can use this form to ask for a reconsideration.
How long it takes the IRE to send you its decision depends on the type of request:
If you disagree with the IRE's decision in level 2, you can request a decision by the Office of Medicare Hearings and Appeals (OMHA). You have 60 days from the date of the IRE's decision to request the ALJ hearing.