Industry News

CMS Issues Medicare Advantage and Medicare Prescription Drug Benefit Programs Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule with comment period, which will strengthen protections, improve health care quality, and reduce costs for Medicare beneficiaries with Medicare Advantage (MA) “Part C” and Medicare Prescription Drug Benefit Program “Part D” in Contract Year 2015.

Key highlights of the proposed rule include the following:

  • Requires physicians and eligible professionals to formally enroll in Medicare by January 1, 2015, in order to write prescriptions for covered Part D drugs.
  • Expands the use of unencrypted prescriber, plan, and pharmacy identifiers contained in prescription drug event records to allow researchers broader access to health care data.
  • Mandates U.S. citizenship and lawful presence as an eligibility requirement for enrollment in Part C, Part D, and cost plans.
  • Increases CMS’ authority to revoke a physician or eligible professional’s Medicare enrollment.
  • Provides CMS authority to impose intermediate sanctions and civil monetary penalties.
  • Allows CMS to request and collect information directly from pharmacy benefit managers, pharmacies, and other FDRs that contract with Part D sponsors.

CMS is accepting comments on the proposed rule no later than March 7, 2014.

The proposed rule is available at:

Medicare Program; Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs; Proposed Rule, 79 Fed. Reg. 7, 1918 (January 10, 2014).