The Centers for Medicare and Medicaid Services (CMS) released its final rule with policy and other technical changes for the Medicare Prescription Drug Benefit Program (Medicare Part D). As expected, the final rule largely adopts the policies already in place under Medicare Part D and promulgated in the May 2007 proposed rule.
Of note is that CMS did not adopt its definition of “administrative costs” or other provisions regarding Part D Plan Sponsors’ categorization of costs, such as payments to pharmacy benefit managers, stating instead that it will revisit this issue in future rulemaking and address comments at that time.
Other provisions of the final rule suggest that Part D Plan Sponsors and their downstream contractors may need to modify certain contracts and internal programs and policies. For example, CMS comments that the expanded pharmacy network access requirements for home infusion, effective for the 2009 benefit year, require Part D Plan Sponsors to “ensure” that clinically necessary professional services and ancillary supplies are in place before home infusion drugs are dispensed.
The final rule was published in the Federal Register on April 15, 2008, and can be found here.