The Centers for Medicare and Medicaid Services (CMS) released yesterday a draft of the 2008 Call Letter, which is the agency’s guidance on the Medicare Advantage and Medicare prescription drug (Part D) programs for the 2008 benefit year. Comments to the draft Call Letter are due to CMS by 5:00 pm on Tuesday, April 3.
The Call Letter sets out CMS’ goals relating to the development of the Medicare Advantage and Part D programs, such as increasing the number of Part D plans offering "at least some brand name as well as generic prescription drug coverage" in the coverage gap and increasing accountability of Medicare Advantage and Part D Plan Sponsors. The following are some of the issues discussed in the Call Letter:
- The Call Letter describes CMS’ expectation for models of care that Special Needs Plans must develop to provide specialized services targeted to the Plans’ special populations.
- The Call Letter explains that CMS may permit a Part D Plan Sponsor to submit four bids if the plan sponsor wishes to offer two plans with coverage in the coverage gap and at least one of these plans offers coverage of all generics and all preferred brands through the entire gap. This represents an expansion of CMS’ general policy, first articulated for the 2007 benefit year, that "more than two bids" from a plan sponsor would not provide meaningful variation—and therefore likely would not be approved—unless one bid provided enhanced alternative coverage that included coverage in the coverage gap.
- The Call Letter also describes CMS’ review of Part D Plan Sponsors’ offering of "Limited Coverage Gap Benefits," meaning coverage for only a subset of covered Part D drugs in the coverage gap.
The draft Call Letter is available on CMS’ website at: http://www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/CallLetter.pdf.