On February 29, the Centers for Medicare & Medicaid Services (CMS) released the final part one guidance for the new Medicare Prescription Payment Plan. The guidance focuses on outlining the necessary operational requirements for Medicare Part D plan sponsors as they prepare for the new program and addresses topics such as identifying Medicare Part D enrollees likely to benefit from the program, the opt-in process for Part D enrollees, program participant protections, and the data collection needed to evaluate the program. The final part one guidance requires Part D sponsors to notify a pharmacy to provide information on the program for anyone who meets a $600 out-of-pocket threshold based on a single prescription at the point-of-sale. This required notification is in addition to the communications that will be provided to people with Medicare Part D before and during the coverage year, as is outlined in the draft part two guidance for the program published on February 15, 2024. The draft part two guidance for the program is open for comment until Saturday, March 16.
CMS also released an Information Collection Request (ICR) for the Medicare Prescription Payment Plan, which includes model materials for Medicare Part D plan sponsors to use when communicating to Part D enrollees about the program. CMS is seeking feedback on the materials through the ICR public comment process. The comment period is open for 60 days, and comments must be received by Monday, April 29.
Click here to view the fact sheet on the Medicare Prescription Payment Plan Final Part One Guidance and here to view the Draft Part Two Guidance.
Click here to view the Information Collection Request for the Medicare Prescription Payment Plan model plan materials.