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Volume 13 Number 54 News: Managed Care The Centers for Medicare & Medicaid Services said in its March 17 final "call letter" to private plans that it will hold off for a year on an electronic prescription reporting requirement, while it works with an industry group. In the final 2009 call letter sent to prescription drug plans and Medicare Advantage plans, CMS said it will wait until 2010 on a requirement that would assist it in evaluating electronic prescribing under the Part D program. The requirement in the draft call letter issued in January (No. 12 HCDR 1/18/08 a0b5r5v8f3), would have mandated reporting, under National Council for Prescription Drug Programs (NCPDP) coding, for Part D sponsors to "adequately identify and report on the source of origin for prescriptions filed." To support the reporting, Part D sponsors would have had to require language within their contracts with pharmacies mandating use of the reporting code. However, in the final call letter, CMS said that it now recognizes that because the reporting field "is currently not widely utilized in industry," it will not be required until 2010. "In preparation for this anticipated 2010 requirement, CMS will collaborate with NCPDP to determine if additional CMS guidance is necessary," the final call letter said. CMS urged plans to work with their network pharmacies to voluntarily begin using the coding in 2009. No Major Changes The final call letter, which combines guidance to Medicare Advantage and prescription drug plans, was little changed from the draft. "We are providing you new information and operational reminders for the Medicare Advantage and other private plan options (Part C) and prescription drug (Part D) programs to help you prepare to help you prepare for contract year 2009," Abby L. Block, director of CMS's Center for Beneficiary Choice, said in the introduction. Commenting on the e-prescribing change, Jean D. LeMasurier, director of the employer group practice at the Gorman Health Group consulting firm, told BNA that, because additional reporting is more burdensome and costly, there likely was a "pushback from the plans and pharmacies during the comment period." Medical Advantage Marketers In the area of Medicare Advantage, CMS placed an added emphasis on helping beneficiaries deal with marketers. CMS told the plans that they must talk to potential enrollees only about the particular product that had been the agreed-to topic prior to the sales meeting. CMS had reminded the plans in the draft that "marketing representatives must clearly identify the types of products that will be discussed before marketing to a potential enrollee." In the section in the final call letter on the MA "cooling-off period," CMS continued that advice and clarified that "additional lines of plan business that are not identified prior to the in-home appointment will require a separate appointment." The final letter is available.
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