The complexity and confusion surrounding Medicare's drug benefit has never been greater. Medicare Part D: A Comprehensive Analysis of CMS Rules distills from thousands of pages of government regulations and guidance the major rules, guidelines and deadlines you need to comprehend this confusing program.

With nine detailed chapters on sponsors, eligibility and enrollment, formularies, CMS enforcement and much more, this valuable analytical tool provides answers to questions such as:

• How does CMS guidance affect marketing?
• How are MA PPOs offering Rx drugs treated under Part D?
• How does enrollment of Medicare/Medicaid dual eligibles affect Part D plans?
• What requirements should Part D sponsors follow when their formularies change?
• What areas does CMS focus on during Part D audits?
• What data do plans need to submit to CMS and when?
• How do e-prescribing standards affect Part D drug plans?
• When should employers continue to provide retiree prescription drug benefits as supplemental, wrap-around coverage? When should they become a PDP, or take the federal retiree drug subsidy?
• What are the implications of the enrollment “lock-in” for Part D marketing?

Arm yourself with the intelligence you need to understand and participate successfully in complex Medicare drug benefit program. Order Medicare Part D: A Comprehensive Analysis of CMS Rules today!

Table of Contents

Chapter 1: Part D Sponsors

Types of Part D Sponsors

Applications

Bids

Part D Waivers

Contract Requirements

Marketing Part D Plans

CMS Payments to Sponsors

Cost Control and Quality Improvement

Chapter 2: Part D Prescription Drug Coverage

Standard Prescription Drug Coverage

Actuarially Equivalent Standard Coverage

Coordination of Benefits

True Out-of-Pocket Costs

Chapter 3: Medicare Advantage Prescription Drug Plans

Types of Plans

Special Needs Plans

Election and Enrollment

Benefits and Beneficiary Protections

Bids

Financial Incentives for Regional MA Plans

Chapter 4: Eligibility and Enrollment

Enrollment

Auto and Facilitated Enrollment

Enrollment Periods

Disenrollment

Chapter 5: Low-Income Subsidy Program

Eligibility Determinations

Subsidies

Administration of Subsidy Program

Payment Provisions for States

Chapter 6: Formulary Requirements

Part D Covered Drugs

Changes to Formularies

Review Process

Model Formulary Guidelines

Chapter 7: Retiree Prescription Drug Benefit

Retiree Prescription Drug Coverage Application

Employer Waivers

Retiree Drug Subsidy Option

Chapter 8: Electronic Prescribing

Use of Electronic Prescribing Standards

E-Prescribing Standards

HIPAA Issues

Anti-Kickback Statute and Stark Exception

Chapter 9: CMS Oversight and Enforcement

Reporting Requirements

Prescription Drug Event Data

Fraud, Waste, and Abuse Compliance Program

Auditing

Written For

• Health plans
• Pharmacy benefit management companies
• Pharmaceutical companies
• Providers that contract with health plans
• Self-insured employers
• Attorneys and consultants

International orders will be fulfilled in PDF format via email.