Medicare Advantage/Part D Drug Benefit Proposed Rule
On May 16, 2008, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule that would revise Medicare Advantage (MA) program and Part D prescription drug program rules. Among many other things, the rule would codify recent marketing guidance documents and impose new requirements, including bans on door-to-door marketing and cold-calling, restrictions on broker/agent commissions, and limits on sales activities at educational events. The proposal also would streamline eligibility determinations under the low-income subsidy (LIS) program and provide new protections for beneficiaries enrolled in special needs plans, including clarified delivery-of-care standards. Moreover, CMS proposes new safeguards to protect beneficiaries from excessive cost-sharing, including refined definitions related to the drug costs Part D sponsors may use as the basis for calculating beneficiary cost sharing, reporting drug costs to CMS for reinsurance reconciliation and risk sharing, and submitting bids to CMS. CMS also proposes a new definition for administrative costs to further clarify costs excluded from Part D drug costs. CMS will accept comments on the proposal until July 15.
