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Each year insurance plan companies and organizations wishing to offer to eligible Medicare beneficiaries the Medicare Prescription Drug Benefit, commonly referred to as the Part D drug benefit, must submit a contract bid to the Centers for Medicare & Medicaid (CMS). Contracts for providing Part D plan coverage to beneficiaries are awarded to companies and organizations whose bid submissions are reviewed and approved by CMS annually. The benefit is offered through Part D Plans (PDPs), Medicare Advantage-Part D (MA-PD) plans, PACE organizations and cost plans.
CMS publishes annually a "Call Letter," which contains annual adjustments and parameters for the defined standard Part D benefit for the upcoming plan contract year. The Call Letter is a key element of the guidance that CMS provides to help PDP organizations bid and contract for the upcoming contract year. It is issued in the early spring of each year in advance of the bid submission deadline in June and contains important new information and operational requirements for Part C, Part D, and cost plan contractors.
Existing policies or new adjustments to the standard Part D benefit for a particular contract year often have direct and indirect impact on LTC pharmacies, consultant pharmacists, and LTC facilities. Since Part D is a common prescription drug benefit for older adults in the community and LTC facility residents, ASCP reviews the draft Call Letter, published prior to March 1, to determine which if any changes imposed on PDP sponsors will create new policy changes for LTC pharmacies, consultant pharmacists or LTC facilities. Industry stakeholders are able to submit comments to CMS on the draft letter during a short comment period prior to the publication of the final Call Letter, published the first Monday in April of each year.
This page contains information and resources pertaining to the Part D CY2014 Call Letter and potential new policies for LTC pharmacies, consultant pharmacists or LTC facilities.
On June 3, CMS released new requirements that all Part D sponsors report valid Patient Residence and Pharmacy Service Type values on Prescription Drug Event (PDE) submissions. CMS stated that it expects that all LTC, home infusion, and specialty pharmacies will know and correctly record the patient residence code on all claims. In addition, CMS expects that all pharmacies, regardless of setting, while know and include the appropriate pharmacy service code on all Part D claims. Claims missing valid patient residence and pharmacy service codes may be rejected by Part D sponsors at point-of-sale.
The Centers for Medicare & Medicaid (CMS) issued April 1 the final version of the Calendar Year (CY) 2014 Medicare Advantage Capitation Rates, Medicare Advantage and Part D Payment Policies, and Final Call Letter (PDF). This announcement outlines requirements for insurance companies planning to submit bids to sponsor Medicare Advantage and Medicare Part D plans for the 2014 plan year. ASCP submitted comments on several sections of the Call Letter section of the document, which outlines several plan requirements that may ultimately impact LTC pharmacy providers and consultant pharmacists. ASCP staff are currently analyzing the Call Letter and will provide a written analysis within the next few days.
In response to the Center for Medicare & Medicaid’s (CMS’s) publication of the draft Medicare Part D Contract Year (CY) 2014 Call Letter, ASCP submitted on March 1, 2013 comments (PDF) on several proposals contained in the document.
The draft Call Letter contains several proposed new policies for Medicare Part D plan (PDP) sponsors that could have impact on LTC pharmacies, consultant pharmacists and LTC facilities. Some of the proposed new policies cover issues such as:
CMS is set to publish the final Call Letter April 1, 2013. ASCP will post the final Call Letter and an analysis of new policies impacting LTC shortly after its publication.