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 Internist Practice Resources
- Where We Stand: Issues of Advocacy
- Council of Early Career Physicians
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.
Internal Medicine Meeting Early Registration Discount
Register early for Internal Medicine Meeting 2015 in Boston, MA to lock in the lowest possible rate. Learn more or register now!
Are You Using ACP Smart Medicine®?
This online clinical decision support tool is a FREE benefit of ACP membership delivering point-of-care access to evidence-based recommendations. Includes more than 500 modules, images and reference tables. Start now or watch the video tour.