Part D Redetermination Request Letter
Builds a Part D redetermination request with its deadline.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Coverage determination notice date
- 2026-09-10
- Enrollee name
- Pat Doe
- Member ID
- X123
- Plan name
- Example PDP
- Drug, strength and quantity
- drug 10 mg, 30 tablets
- Name of enrollee or prescriber signing
- Pat Doe
- Request date
- 2026-09-20
Result: The request is due by November 14, 2026. 1 blank left to fill before sending.
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Coverage determination notice date (YYYY-MM-DD)
- Date the notice was received, if later than presumed (YYYY-MM-DD)
- Enrollee name
- Member ID
- Plan name
- Drug, strength and quantity
- Name of enrollee or prescriber signing
- Ask for an expedited redetermination
The other 3 fields
- The prescriber makes the expedited statement
- Asking for a good-cause extension (filed late)
- Request date (YYYY-MM-DD; blank for today)
How this is calculated
Citation
42 CFR 423.582: a written request within 60 days of receiving the coverage determination, receipt presumed 5 days after its date; a late request only for good cause. 423.584: the expedited standard. 423.590: 7 days, 14 for payment, 72 hours expedited. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.