Health Law Advisory: CMS Finalizes Medicare Part D Negotiated Pricing Regulation and Additional Remaining Revisions to Medicare Advantage and Part D Programs

Yesterday the Centers for Medicare & Medicaid Services (CMS) published in the Federal Register a final rule with comment period (Final Rule) that includes significant changes to the regulations governing the Medicare Prescription Drug benefit (Part D) and the Medicare Advantage (MA) program, as amended by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.1 Most importantly, the new regulations affect Special Needs Plans (SNPs), medical savings account plans, cost sharing for dual eligible enrollees in the MA program, Part D’s prescription drug payment and novation processes, and the enrollment and appeals processes for both programs. The Final Rule also included interim final regulations governing certain aspects of the Retiree Drug Subsidy program (RDS).

The Final Rule becomes effective March 13, 2009, except for the regulations governing SNPs and certain definitions, which will become applicable on January 1, 2010. CMS will accept comments on the provisions concerning the new definitions relating to SNPs and those concerning negotiated prices and retained rebates under the RDS program until March 13, 2009.

Please see full advisory for more information.

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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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