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.