Pharmacies now required by CMS to e-submit Part D prescriptions

A final rule requiring pharmacies participating in the Medicare Part D prescription drug program to electronically submit their Part D prescriptions to patients’ Medicare plan sponsors or their intermediaries, was published by Centers for Medicare and Medicaid Services (CMS) in the Federal Register, reported Health Data Management.

Included in the rule are policy and technology changes to the Medicare Advantage and Medicare Part D prescription drug programs, effective in 2011.

Pharmacies are required under the rule to electronically submit Part D prescriptions to plan sponsors “unless the enrollee expressly requests that a particular claim not be submitted to the Part D sponsor or its intermediary.”

CMS believes that processing claims through Part D sponsors will ensure access to negotiated prices and ensure that a drug utilization review, including patient safety checks, be performed, according to the rule.

The rule also states that “online, real-time processing facilitates accurate accounting for enrollees’ true out-of-pocket and total drug costs by the Part D sponsor so that each claim is processed in the appropriate phase of the benefit and accurate cost sharing assessed.”