New federal rule affects Part D prescribers

On May 23, 2014, there was a new federal rule issued that requires physicians, including psychiatrists and other prescribers of Part D drugs, to be enrolled in Medicare in an approved status or to formally opt out of Medicare to prescribe medications for their Part D patients. However, CMS had to revisit the final rule as a result from learning that certain pharmacists did not meet the definition of ““physician” or “eligible professional” to enroll in Medicare and permitted to prescribe under state laws. These providers would be denied as writing valid prescriptions because the prescriber is neither enrolled in nor opted-out of Medicare.

CMS issued an Interim Final Rule on May 1, 2015 that stated:

  • Part D sponsors are allowed to pay claims for providers who are permitted to prescribe under state law, but who do meet the statutory definitions to enroll in Medicare (referred to as “authorized prescribers”).
  • In addition, for prescribers who are eligible to enroll but have not done so or opted out, a Part D plan sponsor must allow beneficiaries a provisional 3-month supply of their drug and individualized written notice that they are receiving their drug only on a provisional basis.  This provisional supply is meant to give the prescriber time to enroll, or the beneficiary time to find a new prescriber.

These two changes made to the new Interim Final Rule should aid in protecting access to necessary medications for beneficiaries using Medicare Part D.