Medicare Part D Pharmacist-to-Physician Fax Form

The Alzheimer's Association, American Medical Association, American Pharmacists Association, Center for Medicare Advocacy, Medical Group Management Association, National Community Pharmacists Association and the National Council on the Aging have been working together to anticipate and respond to potential problems that may arise when the new Medicare prescription drug benefit is implemented in January 2006. We have been especially concerned that pharmacists and physicians could be overwhelmed in January when millions of low-income patients are switched into their new Medicare drug plans after having been in a Medicaid drug plan or something similar.

The potential exists for confusion because, even though the Centers for Medicare and Medicaid Services (CMS) has provided assurances that plans' formularies will be adequate to meet patients' needs, plans will undoubtedly have policies in place that will differ from patients' current drug plans in some respects. For example, drug plans are likely to utilize lists of preferred drugs with the lowest copays, rules such as that a patient must try a particular drug first before they are covered for the prescribed drug, and preauthorization requirements, besides issues of what drugs are on or off the formulary.

To help mitigate these problems, we jointly developed a form for pharmacists to fax to physicians when there are issues with their Medicare patients' prescriptions (PDF, 28KB; requires Adobe® Reader®). The CMS has provided guidance to plans that during the initial transition/implementation period, they should cover one-time refills even if the drug would not normally be covered by the plan. In that event, the form will allow the physician to consider whether to change the patient's prescription prior to the next refill, or to seek prior authorization, an exception or whatever is most appropriate to keep the patient on the same drug regimen. If the prescription is a new prescription rather than a refill or if the plan will not cover one-time refills, the form can also be used to seek prescription information from physicians immediately while the patient is waiting at the drugstore.

Our organizations are hopeful that the use of this form will allow the new Medicare drug benefit to deliver on its promise of providing good access to a wide array of drugs used by seniors and people with disabilities on Medicare. We strongly encourage pharmacists to utilize the form.