Crosswalk (Notice and Instructions)

Crosswalk for Changes to the standardized pharmacy notice “Medicare Prescription Drug Coverage and Your Rights”

Summary of Changes to CMS-10147

• The language in the third bullet point under the section “Your Medicare Rights” has been reworded to read “a preferred drug” rather than “the preferred drug” to better align this statement with current formulary models and other CMS guidance related to tiering exceptions.

• Alternate format language has been added to the notice to inform beneficiaries of their rights under Section 504 of the Rehabilitation Act of 1973.

• The PRA Disclosure Statement has been added.

• The OMB approval number has been moved to the bottom of the notice and we have added the expiration date.

Summary of Changes to Instructions

• Language to include mail order and specialty pharmacies has been added to clarify that those types of pharmacies are not exempt from the requirement to deliver the notice, and align the instructions with the existing guidance for this notice in Chapter 18, §40.3.1 (“Notification by Network Pharmacists”) of the Medicare Prescription Drug Benefit Manual.

• We’ve added a reference to Chapter 18, §40.3.1 (“Notification by Network Pharmacists”) of the Medicare Prescription Drug Benefit Manual, to improve understanding across the industry of the limited circumstances in which the claim is not paid by Part D but delivery of the notice is not required.

• Minor edits to enhance clarity.

• The form number, OMB approval number, and expiration date have been added to the bottom of the instructions.

• The language specifying that “the OMB control number must be displayed in the upper right corner of the notice” has been reworded to read “the OMB control number must be displayed in the lower right corner of the notice.”