Pharmacy Question for the Week of December 23, 2019

Question:

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

Answer:

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.”