News and Updates

Part D Plans Must Obtain Beneficiaries' Permission Before Transferring Them to Another Pharmacy, Such As Their Own Specialty or Mail-Order Pharmacy

(January 22, 2010)

On January 14, the Centers for Medicare & Medicaid Services (CMS) released a final requirement for Part D drug plans that requires plans to obtain permission from beneficiaries prior to switching them to another network pharmacy for their prescription.  The requirement is effective February 1, 2010.

Last October, CMS had released a draft proposal that would have applied specifically to attempts by Part D plans to switch a beneficiary to a plan's own mail-order pharmacy.

Given several comments from advocates and the industry, CMS revised the transfer request letter that plans must send to beneficiaries to "reflect that any prescription transfer from one pharmacy to another, initiated by the plan, would require release of this notice and permission by the beneficiary."  The agency removed "specific reference to mail-order pharmacy" and made other revisions as listed in its announcement.

• Click here for the CMS announcement.
• Click here for the CMS model beneficiary permission seeking letter and requirements the plan must follow.