 This week, the Centers for Medicare & Medicaid Services (CMS) released for public comment four draft documents that contain potential policy changes for the CY 2007 Medicare Advantage (MA) and Prescription Drug programs. The draft documents are attached below, and include the CY 2007 Formulary Guidance, CY 2007 Transition Guidance, and CY 2007 Call Letters for both Medicare Advantage Prescription Drug plans (MA-PDs) and Stand Alone Prescription Drug Plans (PDPs). The draft 2007 Formulary Guidance outlines how CMS will review Medicare prescription drug benefit plans to assure that beneficiaries receive clinically appropriate medications at the lowest possible cost. Development of this review process was built on two key requirements in the MMA: (1) assuring that drug plans provide access to medically necessary treatments for all and do not discriminate against any particular types of beneficiaries, and (2) encouraging and supporting drug benefit management approaches that are proven and in widespread use by plans today. The draft 2007 Transition Guidance establishes a minimum set of proposed standards for Part D plan sponsor transition policies. Our goal is to ensure that beneficiaries receive clinically appropriate medications at the lowest possible cost, while still recognizing the unique needs of individuals already stabilized on a certain drug regimen. It is also critical that full-benefit dual eligibles who are auto-enrolled in a prescription drug plan understand the changes to their prescription drug coverage as they transition from Medicaid to Medicare. CMS will accept comments on both of these guidance documents until 5:00 PM EST March 6, 2006. The separate MA and PDP Call Letters were issued to convey important information to plans interested in participating in the 2007 contract year. They outline draft policies on issues such as the 2007 renewal process, bidding and payment, eligibility and enrollment, low-income subsidy, marketing and beneficiary communication, systems, compliance and monitoring, formulary, licensure and solvency, pharmacy access, grievances and appeals, claims processing, non-renewals, and employer/union group waiver plans. CMS will accept comments on the Call Letters until 5:00 PM EST March 1, 2006. All of these documents were distributed to current MA and PDP sponsors, and can be found on the CMS web site.
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