CQW Panacea-re-brand-rev3

Pharmacy

For the Week of May 25, 2015

Question:

Does CMS administer the Part D prescription drug program? How are providers paid under this program?

Answer:

CMS does not administer this program; Part D plan insurers do. Medicare pays Part D plans a monthly, risk-adjusted capitation payment for each enrollee. Beneficiaries also pay a monthly premium. Medicare also pays Part D plans additional subsidies to cover reduced cost-sharing for low-income beneficiaries and a portion of the costs for beneficiaries’ whose drug costs are very high.

Following each benefit year, the Centers for Medicare & Medicaid Services (CMS) share risk with plans by reconciling the capitation and various subsidy payments to actual drug cost expenditures determined from prescription drug event (PDE) records, and any manufacturer rebates or other direct and indirect remunerations received by the plan.

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