CMS Guidance on Medicare Part D Links to Key CMS Web Pages
Related ASCP Briefing Rooms
New Information from CMSNovember 24, 2008 CMS Suspends Current Collection of LTC Pharmacy Rebate Data; New Reporting Requirement Will Start in 2010April 3, 2008 CMS Final Rule Modifying the Weighting Methodology Used To Calculate the Low-Income Benchmark AmountJune 27, 2007 CMS Medicare Part D Guidance: Low-Income Subsidy (LIS) Status Corrections Based on Best Available EvidenceJune 14, 2007 CMS Memo to Part D Sponsors: Plans are required to provide prior
authorization criteria to beneficiaries and their physiciansMay 30, 2007 CMS Memo to Part D Sponsors: Special Transition Period for Retroactive EnrollmentMay 24, 2007 CMS Draft Changes to Medicare Part D Regulations; Comments due July 24, 2007May 11, 2007 CMS Booklet: Your Guide to Medicare Prescription Drug Coverage (Revised April 2007) March 23, 2007 CMS Draft 2008 Call Letter for Medicare Part D SponsorsFebruary 15, 2007 Draft CY2008 Medicare Part D Plan Reporting RequirementsFebruary 15, 2007 2007 Final Transition Guidance for Medicare Part DFebruary 15, 2007 Summary of changes between draft 2007 transition guidance and final versionJanuary 5, 2007 CMS Policy Clarification Excludes Medicare Part D Coverage for LTE DESI Drugs (less than effective drug efficacy study implementation)December 29, 2006 CMS Transmittal 1146: Payment by DME MACs and DMERCS for the Administration of Part D VaccinesDecember 22, 2006 CMS Memo to Part D Sponsors: Reconciling Incorrect Cost Sharing Paid by LTC PharmaciesDecember 22, 2006 Point-of-Sale Facilitated Enrollment Process: Four Steps for PharmacistsDecember 6, 2006 CMS Memo to Part D Sponsors: Reconciling CMS Low Income Subsidy (LIS) Status and "Best Available Data" Policy for 2006 and 2007December 1, 2006 Enhanced E1 Transaction Tip SheetDecember 1, 2006 CMS Memo to Part D Sponsors on Part D VaccinesNovember 1, 2006 CMS Memo to Part D Plans on Transition Policies for 2007October 24, 2006 CMS Medicare Part D Reference Document for Pharmacists (14 pages) September 1, 2006 CMS Memo to Part D Plans: Changes to Part D Sponsors' Medication Therapy Management ProgramAugust 21, 2006 CMS Memo to Part D Sponsors with Three Q&As:- Are Part D sponsors required to cover so called "safety syringes" for the administration of insulin?
- Does the exclusion of cough and cold medications extend to all clinical indications of these drugs?
- Under Part D, can a beneficiary donate unused prescription drugs to State agencies or charitable organizations?
July 26, 2006 Final 2007 Marketing Guidelines for Medicare Part DJuly 5, 2006 CMS Memo to Part D Sponsors: Coverage of insulin syringes used in the LTC setting under Medicare Part DJune 14, 2006 Revised CMS Q&A: Contracting Between Part D Plans and LTC Pharmacies Can Not Include Patient ProtectionsJune 6, 2006 CMS Tip Sheet on True Out-of-Pocket Spending (TrOOP)June 1, 2006 CMS Q&A: When Does the Adjudication Timeframe Begin for Exception Requests?June 1, 2006 CMS Q&A: Are Part D plans required to accept the model Medicare Part Coverage Determination Request Form and the model Part D Exception and Prior Authorization Request Form?June 1, 2006 CMS Q&A: Reimbursement to LTC Pharmacies, for Retroactive Subsidy-level Cost Sharing ChargesMay 31, 2006 CMS Memo to Part D Sponsors: FAQs Related to Model Part D Coverage Determination Request Forms
May 30, 2006 CMS Q&A: When reporting Prescription Drug Event Data, may the Plan Sponsor report the amount it pays to the PBM or must it determine and report the amount the PBM pays to the pharmacy?May 26, 2006 CMS Memo to Part D Sponsors: Review of Important 2007 Plan RequirementsMay 26, 2006 CMS Q&A: CMS instructed Part D plans on May 5, 2006 that they are required to use the “best available data” to make changes to their systems when they have knowledge that a dual eligible beneficiary’s cost sharing level is not correct. What does CMS mean by best available data? May 23, 2006 CMS Q&A: Coverage of over-the-counter products under Medicare Part DMay 23, 2006 CMS Memo: CY 2007 Draft Medicare Part D Marketing GuidelinesMay 22, 2006 CMS Memo to Part D Sponsors: Part D Claims Messaging RequirementMay 17, 2006 CMS Q&A: Can Part D Plans Restrict Access to Certain Part D Drugs to "Specialty" Pharmacies within Their Part D Networks?May 15, 2006 CMS Q&A: Are there any notice requirements or other expectations that a plan sponsor must satisfy if it changes a formulary for an upcoming contract plan year?May 12, 2006 CMS Q&A: My patient requested an exception to continue receiving a non-formulary drug that the plan had been providing during the transition period. I submitted a statement to the plan in support of the exception request. The transition period is now over and we haven’t received a decision from the plan. What can be done to make sure my patient continues receiving the drug? May 12, 2006 CMS Q&A: I prescribed a drug for my patient that is not on the plans formulary. etc...May 12, 2006 CMS Q&A: My plan gave me a temporary fill of a non-covered drug that my doctor prescribed, but didn’t tell me that I needed to switch to a drug that is on the plan’s formulary or request an exception. Now, my pharmacist is telling me that I can’t get my prescription refilled. What can I do? May 12, 2006 CMS Q&A: Can a plan establish a generic-use incentive program permitting zero (or reduced) copays on first generic fills if an enrollee agrees to use the generic rather than the brand-name version of a medication? May 12, 2006 CMS Q&A: I asked my plan for a redetermination (first level of appeal) but I haven’t gotten a decision. What should I do? May 11, 2006 CMS Survey and Certification Memo to State Survey Agency Directors: Nursing Homes and Medicare Part DMay 9, 2006 CMS Memo to Part D Sponsors: Claims Filing TimeframesMay 8, 2006 CMS Memo to Part D Sponsors: Increasing Part D Vaccine AccessMay 5, 2006 CMS Memo to Part D Sponsors: Incorrect Cost Sharing Charges to Dual Eligible BeneficiariesMay 3, 2006 Congressional Letter to CMS Administrator McClellan, Urging Revision of CMS Marketing Guidelines to Permit Health Professionals to Assist Beneficiaries in Nursing Facilities in "Choosing Plans with Appropriate Coverage to Meet their Specialized Medication Needs"April 27, 2006 Medicare Prescription Drug Benefit Manual, Chapter 9—Fraud, Waste and AbuseApril 27, 2006 CMS Memo to Part D Sponsors on Formulary Changes During the Plan Year April 20, 2006 CMS Q&A: A new nursing home admission -- who is dual eligible -- is waiting to meet their one calendar month requirement for $0 co-pays, is the facility ever responsible for paying the co-pays?April 19, 2006 CMS Q&A Database: May Part D plans apply drug utilization management edits during a beneficiary’s transition period?April 19, 2006 Remarks of Dr. Mark McClellan, CMS Administrator, Announcing Establishment of the Pharmacy Quality AllianceApril 19, 2006 CMS Q&A Database: Part D Plans May Reimburse LTC Pharmacies Directly for Resident Co-paysApril 19, 2006 CMS Q&A Database: Clarification on Co-pays for Institutionalized
Dual-Eligible IndividualsApril 18, 2006 Letter to CMS Administrator on Standardized Messaging from AHIP/NCPA/NACDS WorkgroupApril 18, 2006 Standardized Messaging for Prescription Transactions - AHIP/NCPA/NACDS WorkgroupApril 18, 2006 Universal Medication Coverage Determination Form for Medicare Part DApril 11, 2006 CMS Memo to Part D Sponsors: Clarification of Coverage of Prescription Niacin Under Part DApril 10, 2006 CMS Q&A: May Part D plans reject claims as "too soon" when an enrollee no longer has access to their previously filled prescription medication because they have been admitted to or discharged from a long term care (LTC) facility?April 5, 2006 CMS Memo to Part D Sponsors with Annual Adjustment for Standard Benefit in 2007April 5, 2006 Medicare Part D Benefit Parameters for Standard Benefit in 2007April 5, 2006 CMS Final CY2007 Transition Guidelines for Part D SponsorsApril 5, 2006 CMS Summary of CY2007 Transition Guideline Changes - Draft to FinalApril 5, 2006 CMS Fact Sheet on CY2007 Transition Guidance for Part D SponsorsApril 4, 2006 HHS Secretary Report III on the Medicare Prescription Drug Benefit ProgramApril 4, 2006 CMS Final Instructions to Medicare Advantage Part D Sponsors for CY2007 ("MA-PD Call Letter")April 3, 2006 CMS Final "Call Letter" with CY2007 Instructions to PDPsMarch 31, 2006 CMS Medicare Part D 2006 Transition Fact SheetMarch 31, 2006 CMS Memo to Part D Sponsors: Critical Steps as Transition Period EndsMarch 31, 2006 Medicare Tip Sheet for Beneficiaries: Getting Drugs After Your Transition PeriodMarch 24, 2006 CMS Final CY2007 Formulary Guidelines for Part D SponsorsMarch 24, 2006 CMS Summary of CY2007 Formulary Guideline Changes—Draft to FinalMarch 21, 2006 CMS Model Pharmacy Notice about the formulary exceptions and appeals process (should be posted or given to beneficiaries interested in contacting a Plan about a coverage determination or formulary exception) March 21, 2006 Instructions for Using the CMS Model Pharmacy NoticeMarch 17, 2006 CMS Memo to Prescription Drug Plans: Makes Part D enrollment of dual eligibles retroactive to date of Medicaid eligibility (eliminating gap in coverage that previously existed)March 17, 2006 CMS Memo to Part D Sponsors on Next Steps on Formulary Transition PoliciesMarch 17, 2006 CMS Memo to State Medicaid Directors on Payment for Home Infusion TherapyMarch 17, 2006 CMS Prescription Drug Benefit Manual, Chapter 18: Part D Enrollee Grievances, Coverage Determinations, and AppealsMarch 15, 2006 Medication Therapy Management Program Submission Announcement for CY2007March 15, 2006 Medication Therapy Management Program Submission Template for CY2007March 14, 2006 CMS Q&A: Payment of Sales Taxes on Prescription Drugs Under Medicare Part DMarch 14, 2006 CMS Resource: Medicare Prescription Drug Coverage—How to File a Complaint, Coverage Determination, or AppealMarch 7, 2006 CMS Memo to Part D Plans on Payment for Home Infusion TherapyMarch 1, 2006 CMS Tip Sheet for Medicare Beneficiaries: Using Medicare Prescription Drug Coverage Before Receiving a Drug Plan Membership CardFebruary 27, 2006 CMS Q&A on Medications Excluded from Part DFebruary 27, 2006 CMS Medicare Part D Resource Fact Sheet for PhysiciansFebruary 23, 2006 CMS Draft CY2007 Formulary Guidance for Part D SponsorsFebruary 23, 2006 CMS Draft CY2007 Transition Guidance for Part D SponsorsFebruary 23, 2006 CMS Fact Sheet: What Drugs do Medicare Drug Plans Cover?February 22, 2006 HHS Secretary Progress Report II on Medicare Drug BenefitFebruary 21, 2006 Draft CMS Medicare Part D “Call Letter” for CY2007February 16, 2006 CMS Memo to Part D Plans Encouraging Use of Patient Locator Code on LTC Pharmacy Claim TransactionsFebruary 13, 2006 CMS Q&A: Follow-Up on Rebate Q&A in Long-Term CareFebruary 9, 2006 CMS Tips for Medicare Beneficiaries When Enrolling in Prescription Drug PlansFebruary 7, 2006 CMS Model Coverage Determination Request Form (for use by beneficiaries) February 7, 2007 Instructions for Use of CMS Model Coverage Determination Request FormFebruary 7, 2006 CMS Memo to Part D Plans: Request for Ninety-Day Payment Window for Prescription ClaimsFebruary 7, 2006 CMS Table: Part D Drugs/Part D Excluded DrugsFebruary 3, 2006 CMS Memo to Part D Sponsors: Permission to Reduce Call Center Hours from 24/7 to 12/7February 3, 2006 CMS Memo to Part D Plans on Coverage of Prescription Niacin ProductsFebruary 2, 2006 CMS Memo to Part D Plans on Extension of Part D Transition through March 31February 1, 2006 HHS Secretary’s One-Month Progress Report on Medicare Part DJanuary 24, 2006 CMS List of Web Links to Resources on Medicare Part DJanuary 16, 2006 CMS Additional Guidance to Part D Plans on Transition PoliciesJanuary 16, 2006 CMS Guidance for Part D Plans on Expedited Processes to Determine Cost-Sharing for Dual-Eligible and Low-Income Subsidy Medicare BeneficiariesJanuary 13, 2006 CMS Memo to Partners About Problems with Medicare Part DJanuary 11, 2006 NDC Health (Per Se) Pharmacy Tips for Eligibility QueriesJanuary 11, 2006 Letter from Dr. Mark McClellan to American Health Care Association About Medicare Part DJanuary 4, 2006 CMS Memo to Part D Plans on Assisting Pharmacies with Claim SubmissionsJanuary 3, 2006 CMS Q&A: Post-Consumption BillingJanuary 6, 2006 CMS Memo to Part D Plans About Transition PoliciesDecember 20, 2005 CMS Fact Sheet on Transition of Dual EligiblesDecember 20, 2005 CMS Guidance: Prescription Drug Costs Under Spend-downDecember 20, 2005 CMS Guidance: Prescription Drug Costs and Post-eligibility for Institutionalized IndividualsCMS Q&A: Long-Term Care Pharmacy and Rebates Under Medicare Part DDecember 12, 2005 CMA Q&A: Health Care Providers Assisting Medicare Beneficiaries with Choosing a Part D PlanNovember 10, 2005 CMS Statement on Part D Plan Contracting with LTC PharmaciesNovember 10, 2005 CMS Q&A: Listing LTC Pharmacies on Part D Plan Web SitesNovember 10, 2005 CMS Q&A: When Does Co-Pay Waiver Take Effect for Dual Eligibles in LTC Facilities?November 8, 2005 CMS Final Marketing Guidelines for Medicare Part D Cover Letter to Updated Medicare Marketing Guidelines Final Medicare Marketing Guidelines Marketing Guidelines Update MatrixNovember 7, 2005 CMS Final Rule: Electronic Prescribing and the Medicare Drug Benefit ProgramOctober 26, 2005 CMS Q&A: Access to LTC Pharmacies for Beneficiaries Residing in ICFs/MR and Institutes for Mental DiseaseJuly 14, 2005 CMS Q&A: Pharmacy Retention of Records Under Medicare Part DJune 27, 2005 CMS Q&A: Collecting Co-Pays from Dual EligiblesJune 27, 2005 CMS Q&A: Access to LTC Pharmacy Services by non-LTC Facilities (e.g. Assisted Living) June 16, 2005 CMS Update to Formulary GuidanceJune 15, 2005 CMS Q&A: Coverage for Medications for Cachexia and Wasting Under Medicare Part DJune 3, 2005 CMS Letter to State Medicaid Directors About Medications Excluded from Medicare Part DJune 2, 2005 CMS Instructions to Prescription Drug Plans on Initial Prescription Fills for LTC ResidentsMarch 16, 2005 CMS Long-Term Care Guidance DocumentMarch 16, 2005 Information for Part D Sponsors on the Transition ProcessMarch 14, 2005 CMS Guidelines for Reviewing Prescription Drug Plan Formularies and ProceduresJanuary 28, 2005 CMS Final Rule on the Medicare Prescription Drug Benefit |
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