Relevant to: Cost, MAOs, MMPs, PDPs
The purpose of this memorandum is to announce that the contract year (CY) 2024 Part C and Part D Baseline Out-of-Pocket Cost (OOPC) Models are available for Medicare Advantage Organizations (MAOs) and Prescription Drug Plans (PDPs) to calculate their updated CY 2024 OOPC values. The values produced from these models are based on CY 2024 approved bids and will serve as the baseline for the Medicare Advantage (MA) Total Beneficiary Cost (TBC) calculation for evaluating the TBC change between CY 2024 and CY 2025. The CY 2025 Part C and Part D Bid Review OOPC Models are expected to be released in April 2024 and will be used in CMS’ review of CY 2025 bids, to include PDP Meaningful Difference and MA TBC reviews. Consistent with last year, the CY 2025 Part D Bid Review OOPC Model will be refreshed in late May 2024.