Fax, Don't Phone, About Part D Problems

Using the fax machine to communicate with Medicare Part D prescription drug plans may save time for family physicians seeking an exception to a drug denial or formulary change, according to the CMS Physician Regulatory Issues Team, or PRIT.

The team responds to physician concerns about the implementation of the Medicare Part D prescription drug benefit through an e-mail complaint form available on the AAFP Web site. Through the complaint system, CMS can log physicians' concerns about patients' access to medications, administrative issues and responsiveness of insurance companies offering Part D plans, said Robert Bennett, PRIT spokesman.

"From multiple conversations with physician practices, it appears more efficient to communicate with prescription drug plans via fax than over the phone," Bennett wrote in an e-mail message to Susan Hildebrandt, assistant director of the AAFP Government Relations Division. "Faxes leave paper trails, and the use of faxes would prevent … staff from wasting their time on the phone."

Prescription plans' fax numbers are available in an Excel file (Excel file: 125 pages / 180 KB. More about downloading files.) that includes contact information for appeals (54 pages) and exceptions (70 pages).

Physicians continue to voice concerns about the time and administrative burdens of prescription plan formulary changes and restrictions, according to Bennett. CMS has required prescription plans to respond to written physician requests for appeals and formulary exceptions within three days for normal requests and 24 hours for expedited requests.

"CMS does not have the authority from Congress to impose time restrictions on how quickly a PDP (prescription drug plan) responds to a phone call," Bennett noted.

Physicians can minimize such formulary issues by downloading and using Epocrates Rx, a free Part D formulary program available through Epocrates, Bennett added.

"By looking up a PDP's specific formulary, the physician can then choose to prescribe a drug that is on the PDP's formulary -- ideally, the physician could write the Rx for a drug that doesn't require a prior authorization," Bennett said. "Even more ideally for the patient, the physician could choose to prescribe the drug that is on the lowest tier, which would minimize the patient's copay."