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You are here: Home / Articles / Reminder: How to Handle Part D Prior Authorization Requests

Reminder: How to Handle Part D Prior Authorization Requests

February 2, 2017 • By From the College

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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.

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Although 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 practice@rheumatology.org.

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Filed Under: From the College, Practice Management, Rheumatoid Arthritis Tagged With: Medicare Part D, Methotrexate, methotrexate prescriptions, Part D Drug, prior authorization, Rheumatoid arthritis

You Might Also Like:
  • Reminder: How to Handle Part D Prior Authorization Requests
  • UnitedHealthcare Retires Fax Numbers Used for Prior Authorization Requests
  • Prior Authorization Struggle Continues
  • Medicare Drug Coverage Plans for Rheumatologic Medications

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ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

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