Healthcare Business News

Docs will need to enroll in Medicare if they want to prescribe Part D drugs

By Paul Demko
Posted: May 19, 2014 - 7:00 pm ET

Doctors and other medical professionals will be required to enroll in the Medicare program to prescribe drugs that are paid for by the federal healthcare program, under a rule finalized Monday by the CMS. The new requirement takes effect June 1, 2015, five months later then the federal agency had initially proposed.

“We have been concerned about instances where unqualified individuals are prescribing Part D drugs,” the CMS wrote in explaining the rationale for the change. “In fact, in a June 2013 report (PDF), the OIG found that the Part D program inappropriately paid for drugs ordered by individuals who clearly did not appear to have the authority to prescribe.”

Doctors and other medical professionals can seek an exemption from the new registration requirement.

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The change is part of a wide-ranging final rule issued by the CMS involving administration of the Medicare prescription drug and Medicare Advantage programs. The proposed rule was initially issued in January and generated more than 7,500 comments. The CMS claims the changes will save the federal government $1.6 billion over the next decade.

The agency is also seeking to crack down on doctors and other medical professionals that are reckless or abusive in prescribing drugs to Medicare patients. The final rule cited another report by the OIG that found abuses in prescription practices by some physicians. For instance, the report noted that 108 physicians scrutinized ordered an average of 71 prescriptions per Medicare beneficiary – or five times the national average.

“The OIG has expressed particular concern over the potential for beneficiaries to become addicted to or otherwise be seriously harmed by certain drugs if they are inappropriately prescribed in dangerously excessive amounts,” the rule states. “We share this concern, particularly as we continue to receive reports of improper prescribing practices.”

Under the new rule, CMS officials will have the authority to strip providers of the ability to enroll in Medicare if their certification by the Drug Enforcement Administration to handle controlled substances has been revoked or if they've been stripped of their authority to prescribe drugs by a state licensing board. In addition, the agency will be able to revoke a provider's Medicare enrollment if they are deemed to have been prescribing drugs in an abusive manner that threatens the safety of patients.

The CMS asserted that this authority would be utilized only in rare instances where abuses have been well-documented. “Honest physicians and eligible professionals who engage in reasonable prescribing activities would not be impacted by our proposal,” the rule states.

Follow Paul Demko on Twitter: @MHpdemko

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