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Medicare Part D (Opt-Out)

The ADA is working with lawmakers, regulators, and others to change a Center for Medicare and Medicaid Services (CMS) rule that requires prescribing dentists—who do not otherwise participate in Medicare—to enroll in (or formally opt-out of) the program before Medicare Part D will reimburse patients for any drugs prescribed. The rule is yet another administrative burden on dentists and an unnecessary restriction on coverage for Medicare Part D enrollees.

Though intended to prevent under qualified or even fraudulent individuals from enrolling in Medicare, there is scant evidence that Medicare Part D prescription fraud is being perpetrated by individuals posing as dentists. The vast majority of dentists do not even participate in Medicare. Moreover, other means already exist to validate that prescriptions are being written by appropriately licensed and credentialed dentists.

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