VBID Prescription Drug Event (PDE) Reporting Guidance for Contract Year (CY) 2023

Relevant to: Current/Prospective Medicare Advantage Organization (MAO) Participants of the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model

The Centers for Medicare & Medicaid Services (CMS) is providing PDE reporting guidance to Part D sponsors participating in the VBID Model. This guidance provides additional clarification and specific PDE examples as a follow-up to the June 1, 2022 email to VBID participants titled, “VBID Model Guidance on Treatment of Reductions in Part D Cost-Sharing.”1

VBID Model participating Part D sponsors are required to report VBID-eligible PDEs (defined as the set of PDEs for a given enrollee where approved VBID Model benefits are being applied) in accordance with this guidance for PDEs that have a Date of Service (DOS) on or after January 1, 2023. CMS does not expect plans to resubmit previously accepted VBID-eligible PDEs with a DOS prior to January 1, 2023 that may have been reported in accordance with a plan’s interpretation of previously published VBID Model guidance that is not consistent with this memorandum.

Click here to download the full guidance as a PDF.