Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or validly opt out in order to prescribe drugs to their patients with a Part D prescription drug benefit plan. The Centers for Medicare & Medicaid Services (CMS) announced that Medicare Part D will no longer cover drugs that are prescribed by physicians or other eligible professionals who are neither validly enrolled, nor opted-out of Medicare. CMS previously announced that enforcement of the prescriber enrollment requirement would begin on February 1, 2017. While CMS is committed to the implementation of the prescriber enrollment requirements, they also recognize the need to minimize the impact on the beneficiary population and ensure beneficiaries have access to the care they need.

To strike this balance, CMS will implement a multifaceted, phased approach that will align full enforcement of the Part D prescriber enrollment requirements with other ongoing CMS initiatives. Full enforcement of the Part D prescriber enrollment requirement will begin on January 1, 2019.

Therefore, all prescribers must be enrolled in the Medicare program by January 1, 2019, to ensure enrollees get their prescriptions.

In the interim, CMS will begin phasing in targeted enforcement of the regulation with additional safeguards to increase prescriber enrollment, identify and eliminate vulnerabilities, and strengthen the Medicare Part D program.

For more information on this requirement, visit the CMS website.