CMS Part D Manufacturer Discount Program: Phase-In Eligible Drug Codes & Download Guide
Relevant to: Part D
Each week, we scan the latest CMS memos to find the most important ones that apply for PACE programs. Below is a summary of what you need to know.
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Introduction
The CMS Part D Manufacturer Discount Program (Discount Program) offers a streamlining opportunity for Part D sponsors, manufacturers, pharmacy benefit managers, and pharmacies. Under the Social Security Act Section 1860D-14C, applicable discounts for select manufacturers’ drugs, introduced as of August 16, 2022, will be phased in from 2025 to 2031. A detailed Microsoft Excel or CSV file provides essential 9-digit National Drug Codes (NDC-9s) eligible for these discounts.
Key Dates and Deadlines
- August 16, 2022: Marketing date for applicable drugs begins
- 2025: Start of multi-year phase-in period for applicable drugs
- 2031: Conclusion of multi-year phase-in period
- May 22, 2025: File update
PACE Compliance
This memo relates to PACE compliance by providing guidelines and updates essential for sponsors, manufacturers, pharmacy benefit managers, and pharmacies involved in the Medicare Part D Manufacturer Discount Program. The program outlines a phase-in of applicable discounts for certain drugs, which directly impacts compliance requirements.
The details within the file about the National Drug Codes (NDC-9s) that are eligible for a phase-in period require precise adherence to CMS requirements. Critical components include:
- The NDC-9 eligibility, which indicates the drugs that can take part in the phase-in when covered under Part D. It is emphasized that this list does not serve as a coverage determination and must not override relevant Medicare or plan criteria.
- Compliance with maintaining accurate records for Phase-In Eligibility, ensuring that start and end dates align with current and future eligibility requirements as determined by CMS.
- The use of csv or Excel formats for reporting implies a need for meticulous data handling to preserve formatting, especially in maintaining leading zeros in numbers such as labeler codes.
Ensuring PACE compliance involves careful attention to submission guidelines and CMS regulations for participating drugs during the specified years of the phase-in period, starting in 2025 and concluding in 2031.
Required Actions
1. Identify and list all phase-in eligible drugs using the provided NDC-9 codes from the downloadable files.
2. Use the specified start and end dates to understand the phase-in eligibility timeframe for each applicable drug.
3. Choose an appropriate method such as Excel import wizard to ensure data integrity while handling the CSV file formats.
FAQs
- “What is the CMS Part D Manufacturer Discount Program?”
- “How does the phase-in period for eligible drugs work under the Discount Program?”
- “What are the eligibility criteria for drugs included in the Manufacturer Discount Program?”
- “How can I open the NDC-9 List file in Excel without altering the data format?”
