CMS outlines 2009 Part D plan requirements

April 14, 2008

CMS will require Medicare Advantage annd prescription drug plan sponsors in the Medicare Part D program, cover more HIV retrovirals, include more MTM data, and specify prior authorization requirements.

The Centers for Medicare & Medicaid Services wants more data, better coverage, and greater transparency from Part D plan sponsors in 2009. In its 2009 Call Letter for Medicare Advantage and prescription drug plan sponsors, CMS is requiring that PDPs publish prior-authorization criteria on their Web sites in advance and that formularies include "all or substantially all" antiretroviral HIV drugs. In 2009 CMS will also require plan sponsors to submit more beneficiary data so that it can expand its analysis of medication therapy management programs.