Q3 2024 Retail Pharmacy Network Analysis Results for Medicare Drug Plans

Relevant to: 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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Click here to read the complete memo from CMS.

Introduction

The Centers for Medicare & Medicaid Services (CMS) recently released the Q3 CY 2024 analysis results regarding retail pharmacy network access for Medicare Prescription Drug Plans. This analysis highlights compliance with the pharmacy access standard, crucial for ensuring beneficiaries have adequate access to retail pharmacies. Plans identified as outliers may be subject to compliance or enforcement actions. Stakeholders have until September 9, 2024, to address any queries.

Key Dates and Deadlines

  • Memo Date: August 27, 2024
  • Deadline to contact for questions or concerns: September 9, 2024

PACE Compliance

This memo pertains to the Retail Pharmacy Network Access and Preferred Cost-Sharing Pharmacy Access Analysis Results for Q3 CY 2024. While this is primarily aimed at Medicare Prescription Drug Plans, there are points of intersection with the PACE programs that need to be considered.

PACE organizations must ensure that their pharmacy networks meet the required access standards as dictated by 42 C.F.R. § 423.120(a)(1). Failing to meet these requirements may result in compliance or enforcement actions.

PACE programs should review the data available in HPMS by navigating through the following path: Quality and Performance > Performance Metrics > Reports > Retail Pharmacy Network Access Data. It is essential to ensure that they are not categorized as access outliers, as this could lead to being scrutinized for compliance by CMS.

For further inquiries related to the plan data, PACE organizations should reach out to the appropriate contact provided in the memo by the specified deadline.

Required Actions

The data from CMS’s retail pharmacy access analyses for Q3 CY 2024 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 September 9, 2024.

FAQs

  • “What are the objectives of the CMS retail pharmacy access analysis?”
  • “How can Medicare Prescription Drug Plans access the Q3 CY 2024 retail pharmacy data?”
  • “What action does CMS take for plans not meeting the pharmacy access requirements?”
  • “What is the deadline to address concerns about plan data for Q3 CY 2024?”
  • “Who should be contacted for questions regarding the retail pharmacy access analysis results?”

Click here to read the complete memo from CMS.

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