Additional CY 2023 PDSS Model Guidance Related to Inflation Reduction Act (IRA) Changes to Part D Coverage of Insulin

Relevant to: Medicare Part D Prescription Drug Plan Sponsors Participating in the Contract Year (CY) 2023 Part D Senior Savings (PDSS) Model

additional clarifying guidance, specific to the Model, for implementing section 11406 (Appropriate Cost Sharing for Covered Insulin Products under Medicare Part D) of the Inflation Reduction Act (IRA, P.L. 117-169). This guidance is specific to CY 2023 PDSS Model. This memorandum also presents the operational approach that the Centers for Medicare & Medicaid Services (CMS) will take when implementing section 11406 of the IRA in the Part D program for Part D plans that are also participating in the PDSS Model and includes Prescription Drug Event (PDE) reporting instructions specifically for PDSS-participating plans to implement the appropriate cost-sharing obligations for covered insulin products.

Click here to download the full guidance as a PDF.