Tip for IRE reconsideration form

The IRE review is conducted by a physician independent of your Part D plan

Tip for IRE reconsideration form

You can submit new evidence directly to the IRE

Tip for IRE reconsideration form

If the IRE overturns the denial, the plan must provide the medication within 72 hours (24 hours for expedited)

Medicarehard

Part D Reconsideration Request (IRE)

IRE reconsideration form · CMS / Independent Review Entity

Level 2 appeal sent to the Independent Review Entity after plan upholds denial. Must be filed within 60 days of the redetermination decision.

Form Details

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Filled by: patient
Frequency: per incident

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Where to Submit This Form

📬

Automatically forwarded by your Part D plan to the IRE

The plan must forward the case. You can also file directly with the IRE (currently Maximus Federal Services).

Filing Deadline

60 days from the date of the plan's unfavorable redetermination.

Required Attachments

📎 All prior appeal documentation (forwarded by the plan)
📎 Any additional clinical evidence or expert opinions
📎 Written statement from you or your representative

Processing Time

Standard: 7 days for Part D. Expedited: 72 hours.

What Happens Next

An independent physician reviewer at the IRE will evaluate the case. If overturned, the plan must provide the drug within 24 hours (expedited) or 72 hours (standard). If upheld, further appeal to an ALJ is available.

Tips for This Form

✓ The IRE review is conducted by a physician independent of your Part D plan
✓ You can submit new evidence directly to the IRE
✓ If the IRE overturns the denial, the plan must provide the medication within 72 hours (24 hours for expedited)
✓ The amount in controversy must meet the threshold for ALJ appeal if the IRE upholds the denial

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the CMS / Independent Review Entity or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.