In its annual Call Letter issued to organizations that intend to offer Medicare Advantage and Prescription Drug Plans, CMS announced steps it is taking to give beneficiaries more information when they make choices regarding the Prescription Drug Plans.
Among other things, Prescription Drug Plan sponsors will be required to outline utilization management criteria on their websites, list specific details about quantity limits and step therapy requirements, and provide comprehensive information about other types of utilization management tools such as prior authorization. Prescription Drug Plan sponsors will also be required to provide additional, easy-to-understand information about coverage in the gap on the Medicare Prescription Drug Plan Finder website. This information will include how the plan will cover brand and generic drugs in the gap.
Organizations can generally use the information contained in the Call Letter to help prepare bids that must be submitted by June 1, 2009. The annual enrollment period for beneficiaries begins Nov. 15, 2009. More than 10 million beneficiaries are enrolled in Medicare Advantage Plans and more than 17 million are enrolled in Part D Prescription Drug Plans. You can view the Call Letter here.