CMS warns against protocol violations of Medicare Part D prescription transfers

BALTIMORE — The Centers for Medicare and Medicaid Services earlier this month released a memo to all Part D sponsors, warning them that the agency has "observed an increase in beneficiary complaints related to the transfer of prescriptions from retail pharmacies to either mail-order or specialty pharmacy without their explicit consent."

According to the memo, the transferring of a prescription from one pharmacy to another that is not initiated by the patient is prohibited without the patient's consent. Unsolicited phone calls made by the plan or pharmacy seeking permission from beneficiaries to transfer a prescription are not permitted.

Also not permitted is the use of prior authorization forms. "The use of other mechanisms, such as prior authorization forms, to steer a beneficiary into a mail-order pharmacy is against CMS requirements and should be discontinued immediately," wrote Cynthia Tudor, director CMS' Medicare Drug Benefit and C & D Data Group. "The choice of which network pharmacy to use is at the sole discretion and convenience of the beneficiary."

"This action by CMS is a step in the right direction," noted Kevin Schweers, SVP public affairs for the National Community Pharmacists Association, in a blog posted Wednesday. "Hopefully, the agency continues to take this issue seriously and applies greater oversight in the future."

In December, NCPA communicated to CMS possible abuses of the protocol Part D plans must follow to document a patient's affirmative decision to switch from one pharmacy to another. In a letter to CMS, NCPA noted: "We have learned that a number of Part D plans across the country are calling and harassing beneficiaries to transfer their prescriptions to a preferred network pharmacy (most commonly a mail-order pharmacy). These plans repeatedly call beneficiaries to make the change. Some plans are even moving patients to mail order without telling them, such that the patient fills a prescription at their community pharmacy and receives a duplicate prescription in the mail.”

For Schweers' full blog post, click here.

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