CVS Caremark Medicare Part D Services may add or remove drugs from our formulary during the year.

The Centers for Medicare and Medicaid Services (CMS) require all Medicare Part D claims submitted with a Patient Residence code of 03 (Nursing Facility) to apply the appropriate dispensing requirements as stated in 42 CFR § 423.154(a)(1)(i), regardless of the pharmacy service type. This requirement states brand oral solid medications for Medicare Part D beneficiaries in a Long-term Care facility must be dispensed in 14-day supply or less increments.

Dear Pharmacy Partner,

Below is an update from our prior January 6, 2017 email communication regarding changes to our Opioid Morphine Equivalent Dose (MED) program that placed edits at the point of sale.