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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. |
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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:
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Timetable:
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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 |