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HHS/CMS | RIN: 0938-AS60 | Publication ID: Fall 2017 |
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: Previously published in the Unified Agenda | Agenda Stage of Rulemaking: Final Rule Stage |
Major: No | Unfunded Mandates: No |
EO 13771 Designation: Fully or Partially Exempt | |
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 to 1395w-152 42 U.S.C. 1395hh |
Legal Deadline:
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Overall Description of Deadline: MMA section 902 requires Medicare final rules publish within three-years of a proposed or interim final rule. Rule may publish before the three-year 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: Katie Mucklow Deputy Director, Division of Policy and Regulations Department of Health and Human Services Centers for Medicare & Medicaid Services Center for Program Integrity, MS: AR-22-56, 7500 Security Boulevard, Baltimore, MD 21244 Phone:410 786-0537 Email: katie.mucklow@cms.hhs.gov |