Medicare Retail Pharmacy Network Access Analysis for AEP CY 2025
Relevant to: PDP, Utilization Management, Part D
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Introduction
The Centers for Medicare & Medicaid Services (CMS) have released the results of their retail pharmacy network access analyses for the Annual Enrollment Period (AEP) of Calendar Year 2025. Available now in the Health Plan Management System (HPMS), these results help determine whether Medicare Prescription Drug Plans meet the established retail pharmacy access standards. Plans failing to meet these standards might face compliance actions, underscoring the importance of timely review and action. Queries regarding plan data should be directed to the provided contacts by December 16, 2024.
Key Dates and Deadlines
- Memo Date: December 2, 2024
- Deadline for inquiries or concerns: December 16, 2024
PACE Compliance
This memo is relevant to PACE programs because it details the results of the retail pharmacy network access analysis for the Annual Election Period (AEP) for the Calendar Year 2025, which is applicable to Medicare Prescription Drug Plans. PACE organizations need to ensure they comply with similar retail pharmacy access standards to deliver prescribed medications effectively.
PACE programs must review their retail pharmacy network access to confirm they meet the minimum access standards required by regulations. Specifically, CMS performs analyses to track compliance with the retail pharmacy access standards as outlined in 42 C.F.R. § 423.120(a)(1).
Non-compliance with these standards may lead to compliance or enforcement actions, which can include restrictions or other penalties. Therefore, it is crucial that PACE organizations review their pharmacy networks carefully to avoid being classified as access outliers by CMS.
PACE programs should consider conducting internal analyses similar to CMS’s assessment to ensure any issues are identified early and addressed promptly to maintain compliance and avoid potential enforcement actions.
Required Actions
1. Review the CMS retail pharmacy access analysis data for AEP CY 2025 available in HPMS.
2. Evaluate your plans to ensure they meet the retail pharmacy access standard as required by 42 C.F.R. § 423.120(a)(1).
3. Address any outliers by contacting PartD_Monitoring@cms.hhs.gov with questions or concerns before December 16, 2024.
FAQs
- “What is the significance of the CMS Retail Pharmacy Network Access analysis for AEP CY 2025?”
- “How can Medicare Prescription Drug Plans access the retail pharmacy access data in HPMS?”
- “What are the consequences for sponsors identified as access outliers in the CMS analysis?”
- “Who should be contacted for questions regarding plan data in the pharmacy access report?”