CMS Signifies Select Questionable Medicare Part D Proposals Won’t Be Finalized

CMS Signifies Select Questionable Medicare Part D Proposals Won't Be Finalized

CMS Signifies Select Questionable Medicare Part D Proposals Won’t Be Finalized


Acknowledging concerns regarding some proposals within the The month of january 2014 suggested rule for that Medicare Advantage and Medicare Part D Programs, the Centers for Medicare & State medicaid programs Services states it will “not intend to finalize” certain proposals at the moment.

Inside a rare, otherwise unparalleled step, Marilyn Tavenner, Administrator for that Centers for Medicare & State medicaid programs Services (CMS) announced inside a March 10, 2014, letter to Repetition. Henry Waxman (D-Calif.) the agency “do[es] not intend to finalize” several questionable proposals targeted at altering the Medicare Prescription Medication (Medicare Part D) Program which were a part of CMS’ The month of january 10, 2014, Medicare Advantage (MA) and Medicare Part D suggested regulation (the Suggested Rule). The letter was issued around the first working day following the close from the Suggested Rule’s comment period, where the company received greater than 7,000 comments. Additionally, it comes amongst intense and growing pressure from various people of Congress and industry stakeholders.

Particularly, CMS’ letter claims that it “received numerous concerns” regarding proposals to:

  • Lift the “protected class” status for 3 of six drug classes-immunosuppressants, antidepressants and antipsychotics-presently enjoying this regulatory protection
  • Set standards on Medicare Part D Plan needs for participation in preferred pharmacy network
  • Reduce the amount of Medicare Part D Plans a component D Plan Sponsor offer and
  • “Clarify” the agency’s interpretation from the statutory non-interference provision

CMS, therefore, doesn’t intend to finalize “these proposals only at that time” and can “engage in further stakeholder input before evolving some or all the alterations in these areas later on years.”

(For any more in-depth description and analysis of those proposals, see our The month of january 23, 2014, About them, “CMS Proposes Significant Changes to Medicare Medicare Part D Program’s Administration”.)

Administrator Tavenner’s letter leaves unanswered, however, numerous queries about the agency’s plans for that Suggested Rule. For instance, the letter’s phrase “preferred pharmacy network” is ambiguous, so it’s unclear if the reference includes the “any willing pharmacy” proposals, which some had to calling the “any willing preferred pharmacy” proposals. Similarly, it’s unclear whether CMS promises to proceed with its proposals regarding pharmacy cost concessions and also the revised meaning of “negotiated cost.” These provisions are thought by a few to become proportional towards the non-interference proposal and also the preferred pharmacy systems, although the proposals are positioned in different parts of the Suggested Rule. Additionally, it remains unclear what effect, or no, Administrator Tavenner’s letter might have around the proposal established within the Feb 21, 2014, Draft MA and Medicare Part D Call Letter regarding network adequacy needs for preferred pharmacy cost-discussing access.

CMS signifies its intention to finalize proposals associated with consumer protections (e.g., making certain use of care during disasters), anti-fraud provisions (e.g., strengthening qualification standards for prescribers) and transparency (e.g., broadening the discharge of Medicare Part D data). The letter is silent on other area D proposals that received significant attention, like the agency’s proposal to change the factors for Medicare beneficiaries’ eligibility to sign up in Medication Therapy Management Programs, thus expanding the scope of those programs, and provisions relevant towards the MA and Medicare Part D Programs, like the proposal to shift to MA Organizations and Medicare Part D Plan Sponsors the duty-and charges-of performance audits.

Comments around the Suggested Rule were due March 7, 2014. CMS is anticipated to produce the ultimate regulation between Spring 2014, prior to the June 2, 2014, deadline for submitting bids for that 2015 benefit year.



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