CMS Issues Memorandum on Reporting Routing Values for the Medicare Prescription Payment Plan
Reporting Routing Values for the Medicare Prescription Payment Plan
- On Sept. 13, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum on Reporting Routing Values for the Medicare Prescription Payment Plan (M3P). This memorandum: Provides instructions to Part D sponsors for populating routing identifier values within the Health Plan Management System (HPMS) for the M3P.
- Clarifies that Part D sponsors must provide an M3P Bank Identification Number (BIN) and Processor Control Number (PCN) and any relevant billing information to the pharmacy for paid claim responses. HPMS currently has a function to report the M3P-specific BIN/PCN.
- Provides instructions on where to enter the BIN/PCN data and how to add the M3P BIN and PCN. Starting Oct. 15, 2024, Part D sponsors must follow the directions to post their report.
- In early November 2024, CMS will extract and publish this information on its website to aid in processing pharmacy claims under the M3P.
Fact Sheet on the Medicare Prescription Payment Plan
- On Sept. 13, 2024, CMS issued a Medicare Prescription Payment Plan Fact Sheet (Fact Sheet) and a Takeaway Card in English, Spanish, Chinese, Korean, and Vietnamese. CMS also published a public-facing website. These documents:
- Provide clarification for Part D enrollees on the purpose and scope of the M3P.
- Provide examples of how a monthly bill is calculated.
- Provide information about additional programs to help lower drug costs.
Part D sponsors may share these documents with Part D enrollees.
- Memorandum
- Fact Sheet
- Takeaway Card
- CMS M3P Website
For questions, please reach out to Vicky Jucelin.
Related
On Dec. 12, 2024, the Centers for Medicare and Medicaid Services (CMS) issued a final rule titled, “Modifications of Health Insurance Portability and Accountability Act of 1996 (HIPAA) National Council for Prescription Drug Programs (NCPDP) Retail Pharmacy Standards; and Modification of the Medicaid Pharmacy Subrogation Standard” (Final Rule).
On December 4, 2024, the Centers for Medicare and Medicaid Services (CMS) announced that two drug manufacturers of gene therapies for sickle cell disease have entered into agreements to participate in the Cell and Gene Therapy Access Model (CGT Access Model).
On November 15, 2024, the Centers for Medicare & Medicaid Services (CMS) issued an update to the set of frequently asked questions (FAQs) related to the Medicare Prescription Payment Plan originally issued on October 1, 2024.
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