CMS releases drug maker agreement in move to close Medicare Part D coverage gap
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The Centers for Medicare & Medicaid Services on Monday took the next step in its bid to close the Medicare Part D coverage gap: It released a drug maker agreement that will secure 50% savings for beneficiaries next year.
Under the healthcare reform law, Medicare Part D beneficiaries who hit the coverage gap in 2011 will be eligible to receive a 50% discount on brand-name drugs and biologics. Drug manufacturers must sign an agreement with CMS to provide that discount in order to remain eligible to offer drugs through the Medicare Part D drug program, according to a CMS news release. CMS is giving $250 checks to beneficiaries who hit the gap, also known as the doughnut hole, this year.
After a review and comment period, CMS revised the manufacturer agreement to provide additional time for quarterly invoice payments by manufacturers to plan sponsors within 38 days of receipt through the Third Party Administrator (TPA). CMS is also providing manufacturers with claims level data necessary to validate invoices, without sharing private patient information, according to the agency.