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Model Part D Exception and Prior Authorization Request Form (“Trigger Form”) for Prescribing Physicians
To further the goal of simplifying procedures in the new drug benefit, last week the American Medical Association (AMA) and America's Health Insurance Plans (AHIP), in conjunction with CMS, released a standardized exceptions form designed to assist physicians in applying for exceptions and prior authorizations on behalf of Medicare beneficiaries enrolled in Medicare drug plans. This form allows for a simplified process for physicians to apply for coverage determinations on behalf of all of their Medicare patients, regardless of which Part D plan the beneficiary is enrolled in.

A model exception and prior authorization request form developed specifically for use by prescribing physicians has been posted to the CMS.gov website, on the Provider Center page under “Part D Tools for Health Care Professionals.” http://www.cms.hhs.gov/center/provider.asp
CMS Model Coverage Determination Request Form

Related Resources

CMS Progress report

CMS Formulary Finder for Prescription Drug Plans