Updated Form Expiration 12/31/2027 – Medicare Drug Coverage and Your Rights Notice
The CMS-10147 Form, also known as the Medicare Drug Coverage and Your Rights Notice, must be distributed to Medicare Part D beneficiaries when a prescription is not covered at the point-of-sale. This notice informs beneficiaries about their right to contact their Part D plan to request a coverage determination, including an exception. The distribution of the CMS-10147 form is a requirement for all pharmacies, including mail order, specialty and LTC. While documentation is not required confirming distribution of the CMS-10147, your pharmacy should have a policy and procedure in place addressing how and when the form is being distributed to patients. PBM field auditors have been known to ask questions about your process and may ask to see a copy of the form to ensure you have the most up-to-date version.
On 02/11/2025, CMS issued a memo to announce the availability of a renewed Medicare Drug Coverage and Your Rights (CMS-10147) “Pharmacy Notice”. While there were no major changes made to the form, the Office of Management and Budget (OMB) approved a new expiration date for OMB Control # 0938-0975. The new expiration date is 12/31/2027.
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- Pharmacies can find the updated version of the Medicare Drug Coverage and Your Rights Notice (Form CMS-10147) and instructions, including Spanish, Chinese, Korean, and Vietnamese translations in the “Downloads” section on the CMS website
- If the form is integrated into your software system, be sure that your software vendor has uploaded the form with the new expiration date of 12/31/2027
- PAAS FWA/HIPAA compliance members should review section 4.5 of their PAAS National® FWA/HIPAA Policy and Procedure manual
- Beneficiaries that reside in a long-term care facility are not exempt from receiving the notice; LTC pharmacies should review our guidance in the manual
- Look for NCPDP reject code 569 with an explanation of “Provide Notice: Medicare Drug Coverage and Your Rights”
- The distribution must take place even if the pharmacy obtains a therapeutic alternative. Getting a prior authorization or change to alternative therapy does not waive the notification requirement
- Pharmacies should act immediately to implement the updated CMS-10147 form with the 12/31/2027 expiration date. You will not be compliant if this is not done by 3/1/2025 as the previous expiration date is 2/28/2025
I have a Bachelor of Science degree from the University of Wisconsin-River Falls and have been a Certified Pharmacy Technician since 2001. Prior to joining the PAAS team, I was a floating technician, 3rd party district chargeback specialist, and district pharmacy training coordinator. Formerly, I was also an instructor for pharmacy technician certification classes.
PAAS’ personal, one-on-one connection will help your pharmacy become more successful in dealing with tiresome PBM audits. It is a pleasure knowing that my colleagues and I can help member pharmacies.
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