Feb 7 -- The Centers for Medicare & Medicaid Services (CMS) invites comments to OMB by March 10, 2023 regarding the CMS Plan Benefit Package (PBP) and Formulary CY 2024.
Under the Medicare Modernization Act (MMA), Medicare Advantage (MA) and Prescription Drug Plan (PDP) organizations are required to submit plan benefit packages for all Medicare beneficiaries residing in their service area. The plan benefit package submission consists of the Plan Benefit Package (PBP) software, formulary file, and supporting documentation, as necessary. MA and PDP organizations use the PBP software to describe their organization's plan benefit packages, including information on premiums, cost sharing, authorization rules, and supplemental benefits. They also generate a formulary to describe their list of drugs, including information on prior authorization, step therapy, tiering, and quantity limits.
CMS requires that MA and PDP organizations submit a completed PBP and formulary as part of the annual bidding process. During this process, organizations prepare their proposed plan benefit packages for the upcoming contract year and submit them to CMS for review and approval. CMS uses this data to review and approve the benefit packages that the plans will offer to Medicare beneficiaries. This allows CMS to review the benefit packages in a consistent way across all submitted bids during with incredibly tight timeframes. This data is also used to populate data on Medicare Plan Finder, which allows beneficiaries to access and compare Medicare Advantage and Prescription Drug plans.
CMS is requesting to continue its use of the PBP module and formulary submission for the collection of benefits and related information for CY 2024. CMS estimates that 779 MA organizations and 60 PDP organizations will be required to submit the plan benefit package information in CY 2023. This is an increase from prior years, where 750 MA organizations and 35 PDP organizations were required to submit. Additionally, the number of CY 2023 formulary submissions decreased from 555 to 542.
Based on operational changes and policy clarifications to the Medicare program and continued input and feedback by the industry, CMS has made the necessary changes to the plan benefit package submission and the formulary layout. Primary changes to the PBP include creating a web-based module within HPMS instead of requiring organizations to download and install the software on their networks, minor adjustments to drop downs, wording of questions, and additional attestations (where applicable).
CMS requires that MA and PDP organizations submit a completed PBP and formulary as part of the annual bidding process. During this process, organizations prepare their proposed plan benefit packages for the upcoming contract year and submit them to CMS for review and approval.
CMS uses this data to review and approve the benefit packages that the plans will offer to Medicare beneficiaries. This allows CMS to review the benefit packages in a consistent way across all submitted bids during with incredibly tight timeframes. This data is also used to populate data on Medicare Plan Finder, which allows beneficiaries to access and compare Medicare Advantage and Prescription Drug plans.
Medicare Plan Finder:
https://www.medicare.gov/plan-compare/#/?year=2023&lang=en
CMS submission to OMB:
https://www.reginfo.gov/public/do/PRAViewICR?ref_nbr=202301-0648-019 Click IC List for information collection instrument, View Supporting Statement for technical documentation. Submit comments through this webpage.
FRN:
https://www.federalregister.gov/d/2023-02579 #1
For AEA members wishing to submit comments, "A Primer on How to Respond to Calls for Comment on Federal Data Collections" is available at
https://www.aeaweb.org/content/file?id=5806