CMS Proposes Major Changes to Medicare Part C and Part D

On Jan. 10, the Centers for Medicare & Medicaid Services (CMS) published proposed rules labeled as ‘‘policy and technical’’ changes to the Medicare Advantage (Part C) and Medicare Prescription Drug Benefit (Part D) Programs. Extensive comments are expected to be submitted by the deadline of March 7, 2014. The proposed rules contain many changes that will materially alter the operations of Medicare Part C and Part D.

The rules include provisions that impose limitations on Medicare plan participation and expansion; impact the agent/broker relationship and compensation structure; change mandatory coverage of certain drug classes; affect the creation and operation of pharmacy networks; create transparency in drug pricing and price reporting; alter the risk adjustment data validation process; and address program integrity issues.

Originally published on BNA’s Medicare Report on March 7, 2014.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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