CMS requires that a notice be made available to enrollees in a Medicare Part D plan, instructing them on how to contact their Part D plan to obtain a coverage determination or ask for a formulary or tier exception if the enrollee disagrees with the information provided by the pharmacist.
According to CMS instructions, “This notice must be distributed to enrollees or conspicuously posted at the pharmacy”. Pharmacies may elect to place their logo in the space above the heading “Medicare Prescription Drug Coverage and Your Rights”.
This is a standard notice and the content may not be changed.
Click on the links below to access the notice.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |