Washington, DC (PRWEB) November 19, 2014
As the Centers for Medicare and Medicaid Services (CMS) steps up audit and enforcement activity, the agency has increased scrutiny of complaints about Medicare Part D beneficiaries not getting timely access to prescription drugs. Atlantic Information Services, Inc. (AIS) is pleased to announce the publication of Complying With Medicare Part D Pharmacy Access Rules: Strategies for Health Plans and PBMs, the latest addition to its Management Insight Series, which details what CMS is looking for when scrutinizing complaints, and offers strategies plans and their partners can institute to prevent pharmaceutical-access problems. The report provides strategies for choosing vendors, administering formularies, making coverage determinations and more.
Complying With Medicare Part D Pharmacy Access Rules offers information on:
- The statutory and regulatory requirements regarding access to pharmaceuticals in Part D and how they are likely to change in the near future.
- What CMS is finding in terms of violations of drug-access standards in its audits and via member complaints, along with the actions — including sanctions and monetary penalties — the agency is taking in response.
- What steps CMS expects Part D plans to take to monitor and oversee their PBMs.
- What regulators are looking for in plans’ policies on prior authorization, step therapy and transition supplies of medications, as shown in case outcomes.
- What regulators expect from plans in their handling of appeals of coverage determinations on pharmaceuticals.
- What CMS expects in terms of outreach to prescribers and beneficiaries on pharmaceutical-access issues, and strategies plans should employ to accomplish this.
- How plans and PBMs should administer formularies to avoid access problems despite the necessity for frequent changes.
The report also includes relevant background coverage of industry developments and federal agencies’ guidance and preparatory materials.
For more information on Complying With Medicare Part D Pharmacy Access Rules, including a full table of contents, visit http://aishealth.com/marketplace/complying-medicare-part-d-pharmacy-access-rules.
AIS’s Management Insight Series is designed to provide practical solutions to complex business challenges with the help of the industry’s most insightful advisors and managers. See a full list of titles in this series at http://aishealth.com/marketplace/insight-series.
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at http://AISHealth.com.