Standardized Pharmacy Notice: Your Prescription Cannot be Filled (f/k/a Medicare Prescription Drug Coverage and Your Rights) (CMS-10147)

ICR 201804-0938-011

OMB: 0938-0975

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Justification for No Material/Nonsubstantive Change
2018-04-17
Supplementary Document
2018-04-17
Supporting Statement A
2018-02-26
Supplementary Document
2017-09-21
Supplementary Document
2017-09-21
IC Document Collections
IC ID
Document
Title
Status
37927 Modified
ICR Details
0938-0975 201804-0938-011
Active 201709-0938-002
HHS/CMS CM-CPC
Standardized Pharmacy Notice: Your Prescription Cannot be Filled (f/k/a Medicare Prescription Drug Coverage and Your Rights) (CMS-10147)
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 05/14/2018
Retrieve Notice of Action (NOA) 04/17/2018
  Inventory as of this Action Requested Previously Approved
02/28/2021 02/28/2021 02/28/2021
40,100,000 0 40,100,000
668,066 0 668,066
0 0 0

Pursuant to 42 CFR 423.562(a)(3) and 423.128(b)(7)(iii), Part D plan sponsors must arrange with their network pharmacies to provide a printed copy of the standardized pharmacy notice to enrollees (beneficiaries) at the point of sale when an enrollee's prescription cannot be filled.

Statute at Large: 18 Stat. 1860 Name of Statute: null
   Statute at Large: 18 Stat. 1852 Name of Statute: null
  
None

Not associated with rulemaking

  82 FR 16843 04/06/2017
82 FR 37453 08/10/2017
Yes

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 40,100,000 40,100,000 0 0 0 0
Annual Time Burden (Hours) 668,066 668,066 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
We propose to revise the notice and accompanying instructions to enhance the clarity and accuracy of the notice and instructions. We also propose to add language that informs beneficiaries of their rights under Section 504 of the Rehabilitation Act of 1973 (Section 504), by alerting the beneficiary to CMS’s nondiscrimination practices and the availability of alternate forms of this notice, if needed. The annual hourly burden associated with this collection is estimated to be 668,066 hours. The annual hourly burden in the 2014 PRA submission for this collection was 626,749 hours. The 41,317 hour increase in burden is an adjustment that is based on the increased number of applicable pharmacies (+6,000 pharmacies) and the increased number of standardized pharmacy notices (+2,479,760 notices) that are likely to be distributed based on CY 2016 prescription drug event data. Reconciling the burden increase: 41,313 hr = 2,479,760 x 0.01666. We attribute the 4 hour difference (41,317 hr – 41,313 hr) to 1 min/response rounding differences (when converted to hours) between this 2017 iteration and the currently approved 2014 iteration. We are also adjusting our cost estimates based on current BLS wage data for pharmacy technicians. In this iteration we are doubling that wage to account for burden and overhead.

$0
No
    No
    No
No
No
No
Uncollected
Mitch Bryman 410 786-5258 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
04/17/2018


© 2024 OMB.report | Privacy Policy