Precluded Prescriber

In accordance with CMS Final Rule CMS-4182-F, CVS Caremark will begin rejecting any claims prescribed be an individual on the Preclusion List effective April 1, 2019.  Claims will reject with the following or similar:

The purpose of this memorandum is to announce the availability of the revised, OMB-approved standardized notice, "Medicare Prescription Drug Coverage and Your Rights" (CMS-10147) ("pharmacy notice").

The Centers for Medicare and Medicaid Services recently proposed regulations that would explore requiring PBMs in Medicare Part D to account for pharmacy DIR fees at point of sale.

CAPS has noticed an increase in pharmacy audits and recoupments for claims prescribed by OIG excluded providers.