Retail Pharmacy Network Access Q3 2024 Analysis Results & Compliance Actions
Relevant to: PDP, Enrollment and Payment Systems, 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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For more information and details, please click here to access the complete memo from CMS.
Introduction
The Centers for Medicare & Medicaid Services (CMS) has unveiled its Q3 CY 2024 retail pharmacy access analysis findings for Medicare Prescription Drug Plans. These analyses are crucial in determining whether plans meet the mandated access standards, and any discrepancies could result in compliance actions. Plan sponsors can review this data within the HPMS system and should reach out to CMS with any questions by the specified deadline.
Key Dates and Deadlines
- Date of Memo: August 27, 2024
- Deadline for Inquiries: September 9, 2024
PACE Compliance
This memo is relevant to PACE programs because of its implications on retail pharmacy network access. PACE organizations must ensure compliance with the retail pharmacy access standards as outlined in 42 C.F.R. § 423.120(a)(1). Failure to meet these standards could result in compliance or enforcement actions by CMS. Therefore, PACE organizations should review the retail pharmacy access data available in HPMS under the specified path to verify compliance.
Pace organizations should particularly note the following actions to maintain compliance:
- Access the Part D retail access data in HPMS by following the specified path: Quality and Performance > Performance Metrics > Reports > Retail Pharmacy Network Access Data > select report period.
- Review your status in relation to the retail pharmacy access standard.
- Address any discrepancies by September 9, 2024, to avoid potential compliance actions.
Ensuring adherence to these standards is crucial in maintaining compliance under the established Medicare guidelines. Please be mindful of the deadline for addressing discrepancies to ensure your organization is not subject to enforcement actions.
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.
FAQs
- “What results were found in the Q3 CY 2024 Retail Pharmacy Network Access analysis?”
- “How can I access the Part D retail access data in HPMS?”
- “What actions might CMS take if a sponsor plan does not meet the required access standard?”
- “Who should I contact if I have questions about my plan data?”
- “What is the deadline to contact CMS regarding plan data questions for Q3 CY 2024?”
For more information and details, please click here to access the complete memo from CMS.