2024 PDE Reporting Guidance for Medicare-Medicaid Plans

Relevant to: PDF, TrOOP, Part D

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Click here to read the complete memo from CMS.

Introduction

The Centers for Medicare & Medicaid Services (CMS) has issued essential guidance for 2024 regarding the Prescription Drug Event (PDE) Reporting for Medicare-Medicaid Plans (MMPs). This guidance addresses technical questions stemming from the Inflation Reduction Act and its impact on cost-sharing for Low-Income Subsidy beneficiaries during the transition from the Coverage Gap Phase to the Catastrophic Phase in Part D benefits. CMS has introduced an MMP reporting adjustment to ensure beneficiaries can move smoothly between these phases in 2024.

Key Dates and Deadlines

  • August 19, 2024: Date of the memorandum issuance.
  • CY 2024: Specific to Prescription Drug Events (PDEs) with Dates of Service in this calendar year.
  • CY 2025: Starting year when Non Covered Plan Paid Amount (NPP) will count towards True Out-of-Pocket Cost (TrOOP).

PACE Compliance & Required Actions

For the CY 2024 PDE reporting guidance related to Medicare-Medicaid Plans (MMPs), the following steps should be taken:

1. Review and understand the new PDE reporting guidance provided by CMS for CY 2024, particularly regarding the application of the MMP reporting adjustment.

2. Ensure that your PDE submissions accurately reflect the newly established guidelines, taking into account the specific instructions and examples provided by CMS, such as determining costs in the Coverage Gap Phase and the Catastrophic Phase transitions.

3. Monitor and oversee PDE submissions to ensure compliance with the updated reporting requirements, utilizing the examples provided to validate the adjustment processes and outcomes.

FAQs

  • What is the CY 2024 Prescription Drug Event (PDE) Reporting Guidance for MMPs?
  • How does the Inflation Reduction Act (IRA) affect cost sharing in the Catastrophic Phase?
  • What is the MMP reporting adjustment and how does it work?
  • How are drug costs determined in the Coverage Gap Phase?
  • What are the implications for low-income subsidy (LIS) beneficiaries under the MMP plan?

Click here to read the complete memo from CMS.

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