Part D Coverage Decision Clock
Part D coverage-decision and exception deadline, in hours from receipt.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Kind of request
- Standard exception (formulary or tiering)
- Plan received the request
- 2026-10-05T14:00
- Exceptions only
- 2026-10-07T09:00
Result: 42 CFR 423.568(b): decision due Saturday, October 10, 2026, 9:00 am, 72 h after the supporting statement.
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Kind of request
- Plan received the request (YYYY-MM-DDTHH:MM)
- Exceptions only: supporting statement received (YYYY-MM-DDTHH:MM)
How this is calculated
Citation
42 CFR 423.568 (standard: 72 hours; exceptions: 72 hours after the supporting statement, or after day 14; payment: 14 days), 423.570 (expedite refused), 423.572 (expedited: 24 hours), 423.578 (exceptions). A missed deadline is forwarded to the IRE within 24 hours. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.