Can the CAP vendor refuse to send a drug the physician ordered?
The CAP vendor generally cannot refuse to ship a drug ordered by a physician. However, the vendor may refuse further shipments to a physician on behalf of a specific beneficiary if the beneficiary has not satisfied his/her cost sharing obligations. However, the CAP vendor must wait at least 45 days from the date of the postmark on the bill before refusing shipment, and if the patient/beneficiary requests financial assistance, the vendor may not refuse shipment until an additional 15 days after the postmark date on any notice offering a payment plan or referral. If the vendor elects to waive the beneficiarys cost-sharing obligations, it may not refuse to ship drugs on that beneficiarys behalf.
