Physician Standardized Form Streamlines Part D Coverage Determinations

Requesting an exception to Medicare Part D plans' off-formulary or restricted drugs has become a bit easier, thanks to a standardized form -- the Medicare Part D Coverage Determination Request Form (PDF file: 1 page / 140 KB. More about PDFs.) -- that CMS and America's Health Insurance Plans are encouraging all insurers to accept.

Physicians can download and fax the form to Medicare Part D plans to request approval of prescriptions that are not in a plan's formulary, seek prior authorization or request a lower copayment level. Use of the form does not guarantee approval, and the form cannot be used to request biotechnology or specialty drugs or drugs such as barbiturates or benzodiazepines, which are excluded by law from all Part D plans.

Some three months in the making, the form is the first in a series of efforts to simplify the process of covering prescriptions for Medicare Part D enrollees, according to Karen Ignagni, president and CEO of America's Health Insurance Plans.

"This effort demonstrates what our community can do collaboratively to streamline administrative processes," she said in an April 11 press release.

Physicians can augment the standard form by completing and including a standard letter (MS Word file: 1 page / 38 KB. More about downloading files.) that includes blanks to fill in for each patient's specific medication issue.