Relevant to: Medicare Advantage Organizations, Prescription Drug Plans, and Section 1876 Cost Plans
Requirements pertaining to the dissemination of Part D information are found at 42 CFR §§ 423.128 and 423.2265(c).
Additional guidance is available in the Medicare Communications and Marketing Guidelines (MCMG) in conjunction with the “Part D Communication Materials” HPMS memorandum from November 1, 2018, and Section 30 of the Medicare Prescription Drug Benefit Manual, Chapter 6. Part D sponsors must include on their website their current drug list or formulary, including tier level and applicable quantity limit (QL) restrictions, prior authorization (PA), limited access (LA), and step therapy (ST) requirements. Part D sponsors must also post all ST and PA criteria documents. CMS monitors the posting and accuracy of these formulary documents. This memorandum provides a summary of the results of Contract Year (CY) 2022 monitoring and announces that CMS will again perform the Posted versus Approved (PvA) Analysis for CY 2023.