The Centers for Medicare and Medicaid Services (CMS) just released two rules finalizing new regulatory requirements for the Medicare Advantage, Medicare Part D and Retiree Drug Subsidy (RDS) Programs. The rules will be published in the Federal Register on January 12, 2009, and comments are due to the agency on or about March 13, 2009.
In a final rule with comment period, the agency adopts several policies initially proposed in May 2008, such as the following:
CMS adopts revisions to the definitions for “gross prescription drug costs,” “allowable drug costs” and “negotiated prices” so that the payment received by the pharmacy, rather than any “locked in” amount paid to a pharmacy benefit manager, is the basis for determining the Part D Plan Sponsor’s costs and the members’ cost-sharing. CMS holds off applying this same policy to the RDS Program, as it had previously proposed, and instead invites further comments on its authority to implement a different policy for the RDS Program.
- The agency finalizes its authority to impose civil money penalties up to $25,000 per member for violations that adversely affect (or have the likelihood of adversely affecting) a member.
- Provider contract requirements relating to cost-sharing obligations for dual eligibles will apply to all Medicare Advantage Plans, not just Special Needs Plans serving dual eligibles.
CMS also issued a proposed rule to expand the agency’s waiver authority to include the RDS Program.