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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) 

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: 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:
Action Source Description Date
Final  Statutory  MMA sec. 902.  05/06/2018 

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.

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:
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