Reminder: CMS will soon require enrollment for Part D prescribing

As we first noted last December, the Centers for Medicare & Medicaid Services (CMS) this year will begin requiring physicians who write prescriptions for Medicare Part D drugs to be either enrolled in Medicare or have a valid record of opting out.

We also noted that while the new policy is effective June 1, CMS has delayed enforcement until Dec. 1. If you aren’t currently enrolled in Medicare or do not have a valid opt-out affidavit on file you should submit an enrollment application or opt-out affidavit to your Part B Medicare Administrative Contractor by June 1. This will ensure that CMS has enough time to process the paperwork ahead of the Dec. 1 deadline and make sure your patients don’t have their Part D prescription drug claims denied.

To prepare prescribers and Part D sponsors for enforcement, CMS is using an online file to identify physicians and eligible professionals who are enrolled in Medicare in an approved or opt out status. The first iteration of the enrollment file is now available. CMS will update the enrollment file every two weeks through the Dec. 1 enforcement date.

Note that enrollment is not the same as participation. A physician can enroll in Medicare without being a “participating” physician.

For more information, including how to enroll online, CMS has published an article, “Provider Enrollment Requirements for Writing Prescriptions for Medicare Part D,” through its MLN Matters information service. You can also find more information on the “Prescriber Enrollment Information” web page on the CMS web site.   

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians