Now that the deadline for eligible seniors to enroll in Medicare’s Part D prescription drug plans has passed, physicians will likely notice increased administrative hassles when prescribing drugs for Medicare patients.

During the enrollment period, plans “opened” their formularies in an effort to reduce phone calls and formulary exception requests from patient and physicians. With the deadline passed, plans will strictly enforce their prescription drug formularies and patients may find that prescriptions plans had previously paid for are not actually included in the plans formularies. Physicians will likely need to appeal prescription denials or request coverage exceptions on behalf of their patients.

Part D plans are permitted to make changes to their formularies as approved by the Centers for Medicare & Medicaid Services. Physicians should be aware, however, that Part D plans cannot limit or exclude previously covered drugs that were prescribed for enrollees before the formulary was changed, unless there are clear scientific or cost reasons (such as the availability of a generic version of the drug or new clinical information).

To minimize administrative Part D hassles, physicians are encouraged to:

1. Verify patients’ insurance information before they are treated.
2. Look up patients’ formularies before writing prescriptions. Part D formularies can be accessed at no charge from Epocrates using your PDA or desktop computer.
3. Use the standardized exception and prior authorization form to request an exception in coverage for nonformulary drugs. (Click here for a list of Part D exception contacts.)

Contact: Kelly Frost 916/551-2883 or kfrost@cmanet.org.