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Plan Formulary Look-up CMS is providing a Plan Formulary look-up tool to help Physicians obtain access to prescription drugs covered under each plan. The plan formulary information is contained with the Formulary Finder on www.medicare.gov. Pharmacy Technical Support Contacts CMS is providing pharmacy technical support phone numbers for all Part D plans. Pharmacists should use these numbers to contact a plan if they have any technical issues preventing a prescription being filled. Exceptions and Appeals Contacts
Pharmacists and physicians should follow the routine procedures of each Part D plan provided on line at the point of sale, including the contact information provided when seeking prior authorization or a formulary exception. This is usual practice. In the event the provider is seeking prior authorization, requesting an exception, or filing an appeal, and the plan's routine protocol fails or the contact is being made after normal business hours, the appropriate telephone number provided in the Exceptions and Appeals Contacts document below may be used.
Medicare Prescription Drug Coverage Provider Communication Form A pharmacist can use this form to communicate information to a physician when a requested drug is not covered by a plan because the drug is subject to a coverage rule or is not on the formulary. CMS is not mandating the use of this form. Model Coverage Determination Request Form for Physicians This form can be used by a physician to request a coverage determination (including an exception) on behalf of a Part D enrollee. This form also allows the physician to submit a statement in support of an exception request. CMS is not mandating the use of this form. Medicare Prescription Drug Coverage Determination Request Form This form can be used to request a coverage determination from a Medicare drug plan. CMS is not mandating the use of this form.
Page Last Modified: 03/11/2008 10:22:28 AM
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