As stated in the CVS Caremark Provider Manual, Medicare Part D Plan Sponsors must arrange with Network Pharmacies to provide Part D Enrollees with a written copy of the standardized pharmacy notice when a Part D Enrollee’s prescription cannot be filled under the Medicare Part D benefit at the point of sale. 42 C.F.R. §§ 423.128(b)(7)(iii) and 423.562(a)(3).

Pharmacies must provide the required Part D Notice of Appeal Rights directly to the Part D Enrollees any time the following reject(s) and related messaging occurs on a claim:

• The pharmacy receives a reject code (NCPDP Field # 511-FB) of "569" << Provide Notice: Medicare Prescription Drug Coverage and Your Rights >> This message is also included on Medicare Part B vs. Medicare Part D rejects (drugs that may be covered under Medicare Part B for the designated Medicare beneficiary).

• Approved message code (NCPDP Field # 548-6F) of "018" << Provide Beneficiary With CMS Notice of Appeal Rights – Claim for a Part D drug submitted to the plan’s Medicare D BIN/PCN is not covered by the Part D plan and is outside the Part D transitional fill coverage period, but is paid under the plan’s co-administered benefit or negotiated price to the beneficiary >>

*Please see attached for more information.