Keeping you updated on the latest Medicare and Part D news

CMS Finalizes CY 2015 Program Changes for Part D

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Last week, CMS released the finalized program changes for Medicare Advantage and Prescription Drug Benefit Programs for the 2015 contract year. The proposals were originally published on January 10, 2014 and open to a 60-day comment period, during which CMS received over 7,500 public comments. Controversial aspects of the proposal, such as regulating preferred pharmacy networks and reducing protected drug classes, were withdrawn by CMS in early March. The finalized changes increase CMS’ oversight to prevent and investigate fraud and inappropriate prescribing. By June 1, 2015, prescribers must either enroll in Medicare or formally opt out. Only those who are enrolled in Medicare can prescribe drugs covered by Part D. Also, CMS can revoke the Medicare enrollment of prescribers with inappropriate prescribing patterns or licensing issues. According to Medicare officials, this authority will only be exercised in “very limited and exceptional circumstances.”

CMS Fact Sheet

ProPublica Article


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