New Process May Help Resolve Part D Prescription Questions

In January, family physicians' fax machines may begin churning out "Request for Prescription Information or Change" forms (PDF file: 1 page / 28 KB. More about PDFs.) from local pharmacists who have been asked to fill prescriptions not covered by patients' Medicare Part D prescription plans.

The form was developed by the AMA, American Pharmacists Association, Medical Group Management Association and four other organizations to help pharmacists and physicians resolve questions expected to arise when low-income Medicare patients' Part D plan formularies differ from their current drug plans. For example, the Medicare Part D plan to which a low-income patient is assigned may require the patient to try a particular preferred drug before the medicine that was actually prescribed is covered.

CMS has said that during Medicare Part D's transition and implementation period prescription drug plans should cover one-time refills for drugs not in the formularies. However, plan administrators are not bound to follow that guidance.

Pharmacists would send the "Request for Prescription Information or Change" form to prescribing physicians when low-income patients attempt to fill or refill prescriptions not covered under the Part D plans to which they have been assigned. The form describes the problem with the prescription and asks the physician to write a different prescription, seek prior authorization or request an exception to the formulary.