Crosswalk: All Instruments

Crosswalk - All Revised Instruments.pdf

Part D Drug Management Program (CMS-10874)

Crosswalk: All Instruments

OMB: 0938-1465

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Part D Drug Management Program Crosswalk of Changes
60-Day ICR Package
2023 Initial Notice

Initial Notice (new version)

Type of
Change1
Rev.
Rev.
Del.

Reason for
Change
Accuracy
Accuracy
Proposed
regulatory
change
Accuracy
Accuracy

Burden
Change
No
No
Yes

Throughout notice
Doctors
Active cancer-related pain

Corrected capitalization
Replaced with “prescribers”
Removed “active” from “active
cancer-related pain”

Member
This form is not required when
only medications are to be limited.

Replaced with “enrollee”
Replaced with “This form is not
required for point-of-sale edits.”

Rev.
Rev.

2023 Model Prescriber Inquiry
Letter
Active cancer-related pain

Model Prescriber Inquiry Letter
(new version)
Removed “active” from “active
cancer-related pain”

Type of
Change
Del.

Reason for
Change
Proposed
regulatory
change

Burden
Change
Yes

2023 Second Notice

Second Notice (new version)

Type of
Change
Rev.
Add.

Reason for
Change
Accuracy
Accuracy

Burden
Change
No
No

Throughout notice
Effective immediately

Corrected capitalization
Added “and for one year from the

No
No

date of this notice.”
Doctors
https://www.medicare.gov/coverag
e/pain-management
This form is not required when
only medications are to be limited.

Replaced with “prescribers”
Bolded text for consistency with
other links
Replaced with “This form is not
required for point-of-sale edits.”

Rev.
Rev.

Accuracy
Consistency

No
No

Rev.

Accuracy

No

2023 Instructions

Instructions (new version)

Heading

Updated assigned ICR number

Type of
Change
Rev.

Reason for
Change
Accuracy

Burden
Change
No

Type of
Change
Rev.

Reason for
Change
Accuracy

Burden
Change
No

30-Day ICR Package

1

Second Notice

Second Notice (new version)

Effective immediately and for one
year from the date of this notice,
your access to medications is
limited in the following way(s)

Replaced “immediately” and “for
one year from the date of this
notice” with variable text

Types of Change: Rev. = Revision, Del. = Deletion, Add. = Addition


File Typeapplication/pdf
File TitlePart D Drug Management Program Crosswalk of Changes
AuthorMDBG-DPDP-VY
File Modified2024:08:01 10:41:03-04:00
File Created2024:08:01 09:32:56-04:00

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