PBM Updates

Definition of Marketing

Relevant to:  Medicare Advantage Organizations, Medicare Advantage-Prescription Drug Plans, Prescription Drug Plan Sponsors, and Section 1876 Cost Plans In order to ensure Medicare beneficiaries are making enrollment decisions based on up-to-date and accurate information, the Centers for Medicare & Medicaid Services (CMS) is issuing this memo to clarify the definition of marketing for Medicare Advantage-Prescription …

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Dual Eligible Special Needs Plan “Look-Alike” Transitions for Contract Year 2024

Relevant to: Current Medicare Advantage Organizations with a Contract Year 2023 Dual Eligible Special Needs Plan (D-SNP) “Look-Alike” Plan This memorandum provides Medicare Advantage (MA) organizations and section 1876 cost plan sponsors serving individuals dually eligible for Medicare and Medicaid with additional guidance on the obligation to refund any payments of excess cost sharing. See …

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