What Medicare Part D Prescribers Need to Know about Enrolling in Medicare

On Oct. 31, 2016, the Centers for Medicare and Medicaid Services (CMS) issued a fact sheet outlining its plan for enforcement of the Medicare Part D prescriber enrollment requirements contained in a final rule it issued in May 2015.

The rule requires that physicians and other eligible professionals (EPs) who prescribe Part D drugs to be enrolled in Medicare in an approved status. It also says that prescribers must be enrolled in an active status or opted out, except in very limited circumstances, in order for their written prescriptions to be covered under Part D. 

Full enforcement of the rule will begin on Jan. 1, 2019.

Prescribers are encouraged to submit their Medicare enrollment applications—or opt-out affidavits for those who elect to opt out of Medicare—to their Part B Medicare Administrative Contractors (MACs) as soon as possible.

HOW TO ENROLL AND CHECK YOUR SUBMISSION STATUS

Those seeking to enroll solely to order and refer and/or prescribe Part D Drugs can submit an application in one of two ways:

  • Online via the PECOS application—For a tutorial, access the CMS how-to guide for the online application process.
  • By mail using the paper CMS-855O form and sending to: Novitas Solutions, Provider Enrollment Services, PO Box 3157, Mechanicsburg, PA 17055-1836.

There is no application fee associated with the submission.

Once you've submitted your application, you can verify that your application has been submitted and is awaiting processing by checking the physician or non-physician list.

The CMS website also provides an enrollment data file identifying physicians and EPs who are enrolled in Medicare in an approved or opt-out status. The file does not specify if a particular prescriber is eligible to prescribe since prescribing authority is largely determined by state law.

CMS offers more information on the Part D prescriber requirement as well FAQs for physicians and other providers.

Pennsylvania Medical Society (PAMED) members with questions can also contact PAMED's Knowledge Center at 855-PAMED4U (855-726-3348) or email KnowledgeCenter@pamedsoc.org.

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