Reminder: How to Handle Part D Prior Authorization Requests

Note: Although originally posted in January 2018, the advice below remains valid. We see this issue recur each year.

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.

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 protected].