Medicare Part D prescription drug benefit plans

This information is being sent to ensure that community mental health providers are familiar with a new federal (Centers for Medicare & Medicaid Services) rule with respect to Medicare prescription drug coverage.

In order for patients with Medicare Part D prescription drug benefit plans to have those benefits covered by Part D, the physician or other eligible prescribing professional who wrote the prescription must either enroll in the Medicare program or opt out of the program. As long as the prescriber has done one of these two actions, the individual's prescriptions will be covered per their Part D benefits. Failure on the part of the prescriber to either enroll or opt out will result in refusal of pharmacy claims for filling these prescriptions, even when the pharmacy itself is a Medicare provider.

Federal communications about when enforcement begins have been inconsistent. All, however, are consistent in identifying NOW as the time prescribers should either enroll in Medicare or do a formal opt-out of the program. If you have prescribing clinicians working with/for you, please go to the following two federal websites to learn more.

http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Prescriber-Enrollment-Information.html

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1434.pdf


Contact Person:

Brenda Cunningham

brenda.cunnigham@illinois.gov