Pharmacy Question for the Week of December 23, 2019

Pharmacy Compliance Question of the Week


How many days of notice must be provided by Medicare Administrative Contractors when they decide that drugs will not be covered?


According to the Medicare Benefit Policy Manuel:

“A/B MACs (A), (B), and (HHH), and DME MACs must provide notice 45 days prior to the date that these drugs will not be covered. During the 45-day time period, A/B MACs (A), (B), and (HHH), and DME MACs will maintain existing medical review and payment procedures. After the 45-day notice, A/B MACs (A), (B), and (HHH), and DME MACs may deny payment for the drugs subject to the notice.”