The CMS is once again putting the brakes on an initiative meant to curb prescribing abuse in the Medicare Part D program.
In March 2014, the agency finalized a rule that mandated doctors and other medical professionals enroll in Medicare to prescribe drugs that are paid for by the federal healthcare program.
The enforcement date, most recently set for Jan. 1, 2016, has moved at least three times. In a letter sent directly to Part D plans on March 1, the CMS stated it is again delaying the rule's enforcement until Feb. 1, 2017.
If a provider isn't enrolled in Medicare by the time the enforcement deadline kicks in, Part D plans will be required to notify patients under that clinician's care that Part D drugs won't be covered if they continue to see that provider.
“We have a responsibility to enforce this crucial program's integrity and basic quality assurance protection for Medicare Part D beneficiaries as soon as possible,” the CMS said in the letter. “However, we also have a responsibility to enforce it in a way that minimizes the potential for disrupting beneficiaries' access to needed Part D medications.”
The agency is encouraging prescribers of Part D drugs to submit their enrollment applications to their Medicare Administrative Contractors before August 1, 2016 to ensure they are processed in time for the new enforcement deadline.
The CMS issued the rule in 2014 because it was concerned about instances in which unqualified individuals were prescribing Part D drugs.
In the most recent letter, the CMS said another delay was necessary to give providers sufficient time to complete their enrollment. It would also give plans and pharmacy benefit managers time to enhance their information-technology systems to comply with the Part D prescriber-enrollment requirement.
The CMS implied that the multiple delays have been called for, in part, because of concerns that providers may not know about the enrollment requirement. The letter asks health plans and pharmacy benefit managers to conduct prescriber outreach.
In data released (PDF) by the agency last year, it estimated that, in 2016, as many as 250,000 prescribers not enrolled in Medicare would be writing prescriptions for 5.25 million beneficiaries. The average Part D beneficiary takes nine drugs prescribed by three prescribers annually.