• rss
  • facebook
  • twitter
  • linkedin

Medicare Part D Coverage Determination Request Form Now Available

A standardized coverage determination request form for the Part D Medicare Prescription Drug benefit has been developed through a collaborated effort between an AMA Part D work group and the health insurance industry. ACP has been an active participant within this process. The Centers for Medicare and Medicaid Services (CMS) is requesting that all plans use this form as a “best practice” and representatives of the health insurance industry expect wide acceptance.

The development of this standardized form is in response to providers’ complaints regarding complications caused by each plan having a different exceptions/appeals form.

The form can be used to request approval for a drug not in a plan’s formulary, for an exception to a formulary tier, and for providing data to meet prior authorization requirements. The form can be used for all drugs except those specifically not covered under the Part D benefit (i.e. barbiturates, benzodiazepines, fertility drugs, drugs prescribed for weight loss, weight gain or hair growth, over the counter drugs or prescription vitamins other than prenatal vitamins and fluoride preparations) and biotech or high cost specialty drugs.

Multimedia Learning Resources

More Related Links:

ACP's Special Interest Groups

Connect with other ACP members through these members-only groups that promote community and networking through lively online discussions. Current groups include ACOs/New Practice Models, Emerging Technology, and more.

ACP's Special Interest Groups

MKSAP 16 Holiday Special: Save 10%

MKSAP 16 Holiday Special:  Save 10%

Use MKSAP 16® to earn MOC points, prepare for ABIM exams and assess your clinical knowledge. For a limited time save 10% when you use priority code MKPROMO! Order now.

Maintenance of Certification:

What if I Still Don't Know Where to Start?

Maintenance of Certification: What if I Still Don't Know Where to Start?

Because the rules are complex and may apply differently depending on when you last certified, ACP has developed a MOC Navigator. This FREE tool can help you understand the impact of MOC, review requirements, guide you in selecting ways to meet the requirements, show you how to enroll, and more. Start navigating now.