Doctors get new tool to cut Part D hassles

The master form more easily will allow physicians to request formulary exceptions now that transitional drug coverage has run out for many patients.

By David Glendinning, AMNews staff. May 1, 2006.

Washington -- Physicians anticipating a major administrative headache every time they want to prescribe a nonapproved drug to a Medicare beneficiary have one less thing to worry about.

The American Medical Association, in collaboration with Medicare drug plans and several physician and patient advocacy groups, has developed a master form that doctors can use to request coverage exceptions on behalf of their patients. The one-page document standardizes and streamlines the information that doctors must provide before they can go outside of a plan's drug formulary or obtain prior authorization for a nonpreferred drug.

The new tool will be a major time-saver for physicians who previously had to deal with multiple, lengthy request forms that differed from plan to plan, said AMA Trustee Edward L. Langston, MD, a family physician in Lafayette, Ind.

"Physicians consider multiple factors in selecting drug therapies for their patients in order to optimize benefits while minimizing problems like drug interactions, side effects and allergies. In order to avoid complications from changes in medication, physicians may need to seek exceptions for some patients," he said. "Physicians will now have a simple one-page form to easily communicate to drug plans why a patient needs a specific drug when other similar drugs are also covered by the plan."

The form includes areas for a doctor to give identifying information about the physician and beneficiary, the patient's medical diagnosis and recommended drug therapy, and the reason why the doctor believes a covered drug will be harmful or less effective.