CMS to track Medicare drug benefit costs

CMS to track Medicare drug benefit costs

The Centers for Medicare & Medicaid Services seeks information to create an efficient framework to track seniors’ out-of-pocket expenses under Medicare’s new drug benefit, referred to as Part D.

CMS needs to be able to calculate when senior enrollees have paid out drug costs to meet the catastrophic limit. To accomplish this, Medicare must be able to collect data from pharmacies, insurers and other third-party payers, CMS, an agency of the Health and Human Services Department, said Friday in its posting on FedBizOpps.

To implement an online process, CMS will require the coordination of enrollment file sharing, claims processing and payment, and application of the protection against high out-of-pocket expenditures by tracking these costs and the annual out-of-pocket threshold. CMS envisions a system of information sharing between CMS, Medicare Part D plans, pharmacies, state pharmaceutical assistance programs, group health plans, insurers and other third-party arrangements.

The agency plans to take advantage of existing architectures, standards and business processes that are part of current industry practices, such as pharmacy transaction standards and network connectivity between pharmacies.

Comments are due by Feb. 4. CMS will release a draft statement of work shortly.

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