Medicare Part D Disclosure to CMS Form

Entity Mandating Form: Centers for Medicare and Medicaid Services (CMS)

Applicability: Entities that provide prescription drug coverage to Medicare Part D-eligible individuals must disclose to CMS whether coverage is "creditable prescription drug coverage":

  • Annually, within 60 days from the beginning of the plan year;
  • Within 30 days after termination of the prescription drug plan; and
  • Within 30 days after any change in the creditable coverage status of the prescription drug plan.

Obtaining This Form: An employer must file this form online on the CMS website.

Additional Resources

Centers for Medicare and Medicaid Services