Beginning with the 2012 plan year, pharmacies must begin distributing a specific notice to Part D enrollees when a prescription cannot be covered (“filled”) under the Medicare Part D benefit at the point-of-sale (POS). The regulation requires distribution of this written notice as of January 1, 2012. CMS recognizes that plan sponsors may need additional time to ensure that operations and systems are in place to fully comply with this requirement. Action for noncompliance will not be taken against a plan sponsor prior to May 1, 2012. Even though a 90 day implementation period has been given for this compliance, it is expected that pharmacies will begin distributing the notice to patients immediately.
Pharmacies may want to contact their system vendor (if applicable) to request that they automate the process so that when a claim rejects, or is rejected by Part D and paid by a supplemental plan, the notice automatically prints.
A Spanish version of the notice will be posted to the CMS website once OMB has approved the translated version of the notice.
For questions concerning the standardized pharmacy notice, please send an email to: PartD_Appeals@cms.hhs.gov.
February 2012 Memo from CMS regarding the Revised Standardized Pharmacy Notice (CMS-10147)
October 2011 Memo from CMS regarding the Revised Standardized Pharmacy Notice (CMS-10147)
Form Instructions for Medicare Prescription Drug Coverage and Your Rights Standardized Pharmacy Notice (CMS-10147)
Approved Medicare Prescription Drug Coverage and Your Rights Form - Word format