Medicare Part D

AMCP Summary: 2018 Draft Call Letter
AMCP summary of “CMS Advance Notice of Methodological Changes for Calendar Year (CY) 2018 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2017 Call Letter” released on February 1, 2017.

AMCP Summary: 2017 Final Call Letter
AMCP summary and side-by-side comparison of the key managed care pharmacy issues and other payment methodology and policy provisions contained in the 2017 Draft Call Letter (released February 19, 2016) versus the 2017 Final Call Letter (released April 4, 2016).

AMCP Summary: Request for Public Comment on the Proposed Enhanced MTM Model Encounter Data Structure and Pilot Monitoring Measures
AMCP summary of memorandum and draft specification plan released by CMMI on February 26, 2016 outlining the proposed data structure and pilot monitoring measures for the enhanced MTM model test scheduled to begin in January 2017.

AMCP Summary - 2017 Draft Call Letter
AMCP summary of “CMS Advance Notice of Methodological Changes for Calendar Year (CY) 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2017 Call Letter” released on February 19, 2016.

AMCP Summary - CMS-CMMI Enhanced MTM Model Beginning in 2017
CMMI will begin testing new payment models for MTM in January 2017 for stand-alone prescription drug plans under Medicare Part D. AMCP provides this summary of CMS' requirements to participate.

CMS Announces Opportunity for Enhanced MTM Test Model Beginning in 2017
This memorandum announces the Part D Enhanced Medication Therapy Management (MTM) Model, and provides preliminary information to sponsors of stand-alone individual market basic PDPs interested in participation.

CMS 2016 Formulary Information
CMS memorandum describing the process for submitting formulary updates for CY 2016

2016 CMS Final Medicare Part D Call Letter
In accordance with section 1853(b)(1) of the Social Security Act, we are notifying you of the annual Medicare Advantage (MA) capitation rate for each MA payment area for CY 2016 and the risk and other factors to be used in adjusting such rates. 

2016 CMS Memorandum for Medicare Part D MTM
This memorandum provides guidance to Part D sponsors regarding contract year 2016 MTM programs. 

Medicare Prescription Drug Benefit Manual: Chapter 6-Part D Drugs and Formulary Requirements
Medicare Prescription Drug Benefit Manual Chapter 6 – Part D Drugs and Formulary Requirements; Revised January 15, 2016.

2015 CMS Guidance for Medicare Part D in Payment for Hospice Drugs 
The purpose of this memorandum is to announce CMS' intention to continue the 2014 Part D hospice guidance through 2015. Sponsors should consider this as they develop bids for coverage year 2015.

AMCP Summary of CMS Final Rule for Medicare Part D and Medicare Advantage Programs
AMCP Summary of CMS Final Rule for Medicare Part D and Medicare Advantage Programs Allows Certain Medication Therapy Management (MTM) and Fraud Prevention Activities to Count toward Medical Loss Ratio (MLR). 

CMS December 2015 Memorandum on Part D Transition Monitoring Program
This memorandum provides Part D sponsors with an overview of the CY 2015 Transition Monitoring Program Analysis (TMPA) results and provides details about continuing TMPA in CY 2016.

CMS 2014 Policy for Automatic Delivery of Prescriptions under Part D
CMS provides guidance and clarification to plans on automatic shipment of new and refill prescriptions under Medicare Part D.

CMS Final Rule on Medical Loss Ratio for Medicare Part D and Medicare Advantage Plans
The Centers for Medicare and Medicaid Services Final Rule on Medical Loss Ratio requirements for Medicare Advantage and Medicare Prescription Drug Benefit Program.

CMS Issues 2015 Draft Call Letter
Advance notice of methodological changes for calendar year 2015 for Medicare Advantage (MA) capitation rates, Part C and Part D payment policies and 2015 call letter.

CMS Issues 2015 Final Call Letter
Announcement of Calendar Year (CY) 2015 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter. In accordance with section 1853(b)(1) of the Social Security Act (the Act), we are notifying you of the annual Medicare Advantage (MA) capitation rate for each MA payment area for CY 2015 and the risk and other factors to be used in adjusting such rates.

CMS Issues 2016 Draft Call Letter for Medicare Part D and Medicare Advantage Plans (2.20.15)
The Centers for Medicare and Medicaid Services (CMS) issues advance notice of methodological changes for calendar year 2016 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2016 Call Letter. In accordance with section 1853(b)(2) of the Social Security Act, we are notifying you of planned changes in the MA capitation rate methodology and risk adjustment methodology applied under Part C of the Act for CY 2016. Also included with this notice are proposed changes in the payment methodology for CY 2016 for Part D benefits and annual adjustments for CY 2016 to the Medicare Part D benefit parameters for the defined standard benefit.

CMS Issues Guidance for Compliance with Any Willing Provider Requirements
CMS provides clarification on the transparency and timing of sponsors' AWP contracting process as well as the content of their standard terms and conditions.

CMS Issues New Hospice Guidance in July 2014; Supersedes Previous Guidance Released in March 2014
CMS Updates Hospice Coverage Policy for Medications…Again! July 2014 The Centers for Medicare and Medicaid Services (CMS) recently released an updated guidance and standard prior authorization (PA) form for medication coverage for hospice beneficiaries.

CMS Medicare Part D HCP Memo to Sponsors
Rescheduling of Hydrocodone Combination Products from Schedule III to Schedule II.

CMS Proposed Rule on Medicare Program; Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs
The Centers for Medicare and Medicaid Services (CMS) recently released an updated guidance and standard prior authorization (PA) form for medication coverage for hospice beneficiaries. It supersedes a guidance released on March 10, 2014 (but implemented on May 1, 2014).

CMS Releases Preliminary Findings from Medicare Part D Preferred Cost Sharing Study
Convenient Access to Retail Pharmacies - Analysis on Preferred Cost-Sharing Pharmacy Networks.

Summary of CMS Final Rule for Medical Loss Ratio requirements for Medicare Advantage and Medicare Prescription Drug Benefit Program
CMS Final Rule for Medicare Part D and Medicare Advantage Programs Allows Certain Medication Therapy Management (MTM) and Fraud Prevention Activities to Count toward Medical Loss Ratio (MLR).

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