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Part D Prescriber Enrollment - Home

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Medicare Part D may no longer cover drugs that are prescribed by physicians or other eligible professionals who are neither validly enrolled, nor opted out of Medicare. CMS previously announced that enforcement of the prescriber enrollment requirement would begin on February 1, 2017.  While CMS is committed to the implementation of the prescriber enrollment requirements, CMS also recognizes the need to minimize the impact on the beneficiary population and ensure beneficiaries have access to the care they need.  

To strike this balance, CMS will implement a multifaceted, phased approach that will align full enforcement of the Part D prescriber enrollment requirements with other ongoing CMS initiatives. Full enforcement of the Part D prescriber enrollment requirement will begin on January 1, 2019.

All prescribers must be enrolled by January 1, 2019 to ensure enrollees get their prescriptions.  

However, in the interim, CMS will begin phasing in targeted enforcement of the regulation with additional safeguards to increase prescriber enrollment, identify and eliminate vulnerabilities, and strengthen the Medicare Part D program :

  • Precluded Physicians and other Prescribers-The prescriber enrollment requirement will be enforced with respect to prescriptions written by individuals who are currently excluded by the OIG, who are revoked by the Medicare program, or who are non-enrolled prescribers with a felony conviction within the last 10 years.
  • CMS will create an easy enrollment application to allow prescribers to review, update, electronically sign and submit a pre-populated enrollment application online.
  • CMS will continue targeted outreach and education activities to unenrolled prescribers to include direct mailings, participation in sponsored events and coordination with the Part D plans to encourage enrollment).

Please visit the Prescriber Enrollment Fact Sheet here.

While the full implementation date is January 2019, CMS encourages all providers who prescribe Part D drugs, but are not yet enrolled or validly opted out of Medicare, to enroll in the Medicare Program now.

Medicare Administrative Contractors (MACs) are here to help. Locate the MAC that services your geographic area.

For Dentists

Check Your Enrollment Status

Check the enrollment file on the CMS website to confirm your enrollment status in the Medicare program. As per industry feedback CMS is posting an enhanced TEST version of the enrollment file. Please check the test enrollment file.

Enroll to Prescribe

- Enroll online: Use PECOS, the online application, to fast-track your enrollment. Our how-to guide is here to help.
OR
- Enroll offline: You may mail in your paper application instead.

To learn more, visit our How to Enroll page.

Learn more about Opting-Out

Physicians and practitioners may opt-out of Medicare. Please note that you must enroll in Medicare in order to prescribe drugs covered by a Medicare Advantage plan. If you opt-out of Medicare, you may not receive reimbursement from a Medicare Advantage plan.

Use the decision matrix to learn more about the impact of opting out. This will not only impact you, but it may affect your patients' ability to be covered.

 

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