Q1 2025 Retail Pharmacy Network Access Analysis Results
Relevant to: PDP, Drug Pricing, Part D
Each week, we scan the latest CMS memos to find the most important ones that apply for PACE programs. Below is a summary of what you need to know.
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Introduction
The Centers for Medicare & Medicaid Services (CMS) has released the retail pharmacy network access and preferred cost-sharing pharmacy access analysis results for the first quarter of 2025. The detailed analysis is available for review in the Health Plan Management System (HPMS), providing insights into prescription drug plans’ compliance with retail pharmacy access standards. Outliers identified may be subject to potential compliance or enforcement measures.
Key Dates and Deadlines
- March 26, 2025: CMS retail pharmacy access data for Q1 CY 2025 is available
- By April 9, 2025: Deadline to contact CMS with questions or concerns about plan data
PACE Compliance
This memo is relevant to PACE programs because it outlines the compliance requirements for retail pharmacy network access for Medicare Prescription Drug Plans. These requirements are essential for maintaining the quality and accessibility of services within the PACE programs.
Plans must ensure their pharmacy networks meet the retail access standards as detailed in 42 C.F.R. § 423.120(a)(1). Failing to meet these standards could lead to compliance or enforcement actions, which might affect the funding or operation of PACE programs.
It is crucial for plans to review the data available in the HPMS and assess whether they are meeting the necessary retail pharmacy access standards. The available data can be found by navigating to:
- Quality and Performance
- Performance Metrics
- Reports
- Retail Pharmacy Network Access Data
Sponsors flagged as access outliers should prepare to take corrective actions to align with the requirements, ensuring sustained compliance and avoiding potential sanctions.
Required Actions
The data from CMS’s retail pharmacy access analyses for Q1 CY 2025 are now available in HPMS for review. To access the Part D retail access data in HPMS, please follow this path: Quality and Performance > Performance Metrics > Reports > Retail Pharmacy Network Access Data > select report period. CMS will use the analysis to identify sponsors’ plans that are not meeting the retail pharmacy access standard required by 42 C.F.R. § 423.120(a)(1). Sponsors identified as access outliers may receive compliance or enforcement actions. For questions or concerns about your plan data please contact PartD_Monitoring@cms.hhs.gov by April 9, 2025.
FAQs
- “How can I access the CMS retail pharmacy access analysis for Q1 CY 2025?”
- “What steps does CMS take for plans not meeting retail pharmacy access standards?”
- “Who should be contacted for questions regarding plan data?”
- “What is the deadline for contacting CMS with questions about plan data?”
- “What is the CMS retail pharmacy network access standard under 42 C.F.R. § 423.120(a)(1)?”
