New Requirements for Prescribers of Medicare Part D Drugs

The Centers for Medicare & Medicaid Services (CMS) finalized CMS-4159-F, “Medicare Program; Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs” on May 23, 2014. This rule requires physicians and, when applicable, other eligible professionals who write prescriptions for Part D drugs to:

• be enrolled in Medicare in an approved status, or
• have a valid opt-out affidavit on file for their prescriptions to be covered under Part D.

The final regulation stated that the effective date for this requirement would be June 1, 2015.  However, CMS is announcing that it will delay enforcement until December 1, 2015 of the requirements in 42 CFR § 423.120(c)(6). 

You have been identified as a physician or eligible professional who writes prescriptions for Part D drugs but is not currently enrolled in Medicare in an approved status or does not have a valid opt-out affidavit on file.  You must submit a Medicare enrollment application or opt-out affidavit by June 1, 2015, or earlier, to ensure sufficient processing times and avoid your patients’ prescription drug claims from being denied by their Part D plans beginning December 1, 2015. 

For more information on the Part D enrollment requirements, and how to enroll via the web, refer to MLN Matters Article SE1434, http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1434.pdf, “Provider Enrollment Requirements for Writing Prescriptions for Medicare Part D Drugs.”  Questions may be directed to providerenrollment@cms.hhs.gov.