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HHS/CMS RIN: 0938-AS60 Publication ID: Spring 2015 
Title: ●Changes to the Requirements for Part D Prescribers (CMS-6107-F) 
Abstract:

This rule finalizes the interim final rule that revises requirements related to beneficiary access to covered part D drugs. Under these requirements, pharmacy claims and beneficiary requests for reimbursement for Medicare part D prescriptions, written by prescribers other than physicians and eligible professionals who are permitted by state or other applicable law to prescribe medications, will not be rejected at the point of sale or denied by the plan if all other requirements are met.  In addition, a plan sponsor will not reject a claim or beneficiary request for reimbursement for a drug without first providing provisional coverage of the drug and individualized written notice to the beneficiary.  This rule also revises certain terminology to assure consistency with existing policy and to improve clarity.

 
Agency: Department of Health and Human Services(HHS)  Priority: Other Significant 
RIN Status: First time published in the Unified Agenda Agenda Stage of Rulemaking: Final Rule Stage 
Major: No  Unfunded Mandates: No 
CFR Citation: 42 CFR 423   
Legal Authority: Pub. L. 111-148, sec 6405(c)    42 U.S.C. 1302    42 U.S.C. 1395w-101 through 1395w-152    42 U.S.C. 1395hh   
Legal Deadline:
Action Source Description Date
Final  Statutory  MMA Section 902.  05/06/2018 
Timetable:
Action Date FR Cite
Interim Final Rule  05/06/2015  80 FR 25958   
Interim Final Rule Effective  06/01/2015 
Interim Final Rule Comment Period End  07/06/2015 
Final Action  05/00/2018 
Regulatory Flexibility Analysis Required: No  Government Levels Affected: None 
Small Entities Affected: No  Federalism: No 
Included in the Regulatory Plan: No 
RIN Data Printed in the FR: No 
Agency Contact:
John Spiegel
Director, Division of Policy and Regulatory Development, Medicare Program Integrity Group
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Center for Program Integrity, MS: AR-18-50, 7500 Security Boulevard,
Baltimore, MD 21244
Phone:410 786-1909
Fax:410 786-0604
Email: john.spiegel@cms.hhs.gov