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MedicaidCMS Releases Part D E-Prescribing Final Rule

CMS released the Part D electronic prescribing final rule on April 2, 2008, establishing Part D e‑prescribing standards for four types of information.  The standards adopted under the rule will apply to all Part D sponsors, as well as to prescribers and dispensers that electronically transmit prescriptions and prescription-related information about Part D covered drugs prescribed for Part D eligible individuals.  The rule adopts four standards for use in e-prescribing:

  • Formulary and benefits: Allows prescribers to communicate with Part D sponsors about which drugs are covered by the patient's prescription drug benefit plan. Prescribers can also learn which generic prescription drugs might offer lower-cost options for the individual.
  • Medication history: Allows providers, dispensers and Part D sponsors to communicate among themselves about prescribed medications a beneficiary has taken or is taking, including those prescribed by other providers. This information can help reduce the number of adverse drug events and can help ensure that the prescriber has the necessary information about a beneficiary's current prescription medications.
  • Fill status notification: Allows providers to receive an e-mail notice from dispensers telling them that a patient's prescription has been picked up, not picked up, or has been partially filled. These notifications can help health care providers monitor patients with chronic conditions by providing an indicator as to whether they are taking their medicines.
  • Provider identifier: Requires providers, dispensers, and Part D sponsors to use the National Provider Identifier (NPI) to identify individual health care providers in Part D e‑prescribing transactions. Adoption of the NPI will speed workflows by eliminating call-backs by pharmacies to medical offices to verify the identity of individual prescribers.

The new Part D e‑prescribing standards, which will be effective on April 1, 2009, supplement a set of "foundation" standards which took effect with the start of Part D on January 1, 2006.  For more information, please see the CMS  Press Release or visit the CMS E-Prescribing  website, where the final rule on Part D e‑prescribing standards (CMS-0016-F/CMS-0018-F) and the earlier final rule establishing e‑prescribing foundation standards (CMS-0011-F) will be available.

CMS Acts to Reduce the Number of Yearly Drug Plan Reassignments for Low-Income Beneficiaries

CMS has issued a final regulation that could allow nearly one million Medicare beneficiaries with limited income and resources to remain in the Medicare prescription drug plan in which they are enrolled without having to pay a premium. 

Under the final rule, the regional LIS benchmarks will be weighted based on each plan's share of enrollees receiving the low-income subsidy, rather than their share of total Part D enrollment.  This means plans with a greater number of low-income subsidy enrollees will be a larger factor when CMS calculates the benchmark.  This will help to ensure that the premium subsidy amount better reflects the plans that low-income subsidy beneficiaries are enrolled in and will result in fewer LIS beneficiaries seeing their drug coverage disrupted by having to change prescription drug plans in order to avoid paying a premium.  The  Final rule is effective May 31, 2008.  For more information, please also see the CMS   March 31 Press Release.

Chris Worrall
Special Assistant
Centers for Medicare & Medicaid Services
Office of the Administrator
200 Independence Ave. SW
Washington, D.C. 20201

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