Revised Standard Pharmacy Notice
posted: 10/26/2011

Beginning with the 2012 plan year, each Medicare Part D plan sponsor must have a system in place that transmits codes to network pharmacies to instruct the pharmacies to provide a printed notice to enrollees when a prescription cannot be covered (filled) under the Medicare Part D benefit at the point-of-sale (POS). The printed POS notice will tell enrollees how to request a coverage determination by contacting the plan sponsor’s toll-free customer service line or by accessing the plan sponsor’s Web site. 

Since the inception of the Part D program in 2006, sponsors have been required under 42 CFR 423.562(a)(3) to arrange with their network pharmacies to post or distribute notices that instruct enrollees to contact their plans for a coverage determination if they disagree with information being provided by the pharmacist. The standardized pharmacy notice (CMS-10147) that has been used for this purpose is now being revised, through the Paperwork Reduction Act (PRA) process, which includes two opportunities for public review and comment. 

Most recently, the revised notice was published on Sept. 16, 2011, for a final 30-day comment period. The revised pharmacy notice and related supporting documents can also be found online. The Centers for Medicare and Medicaid Services (CMS) anticipates that the new standardized pharmacy notice will be made final in November, after which it will be posted immediately on the CMS Web site. The most recent revised notice is also available in the Medicare information section of the MPA Web site under ‘General Information.’


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