As we begin another new year, many rheumatology practices will again receive prior authorization requests from Medicare Part D for all methotrexate prescriptions. When methotrexate is used as a chemotherapeutic drug, it’s covered by Part B, but when it’s used as an oral agent for rheumatoid arthritis, it’s covered by Part D.
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Early in the evolution of Part D, the Centers for Medicare and Medicaid (CMS) suggested that when writing a prescription for oral methotrexate, rheumatologists write the words “Part D drug” on the prescription as documentation for the Part D plan.
Although the CMS has instructed plans to stop requiring prior authorization for methotrexate prescriptions, the issue has not been resolved. The ACR continues to work toward a resolution, but to minimize prior authorization requests and denials, it is very important for rheumatology practices to continue writing the words “Part D Drug—for Rheumatoid Arthritis” on every prescription for drugs that are sometimes covered by Part B. Remember: Part D plans are not permitted to pay for drugs that should be billed to Part B. This statement informs the plans that the prescription is a valid Part D prescription.
If you are experiencing issues with a Part D plan and prior authorization requests for methotrexate or another drug, contact the ACR practice advocacy department at email@example.com.