Medicare Prescription Payment Plan (M3P) Implementation: Key Considerations for Part D Plan Sponsors and PBMs
The upcoming Medicare Prescription Payment Plan (M3P), set to launch in January 2025, marks a significant shift in Medicare’s approach
Regulatory Compliance
Streamlining Medicare Advantage Organizations Member Communication: A Guide to CMS’s Model Materials for CY 2025
Every year, Medicare Advantage Organizations (MAO)1 must update their member communication materials, such as the Annual Notice of Change (ANOC),
Ensuring Accurate Drug Claims: Insights from CMS Audits and Best Practices
Updated October 2026: this post summarizes a CMS audit of immunosuppressant claims (Part B vs Part D) and a February
Capitation Rates Announcement for Medicare Advantage Plans for CY 2025
The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025
Changes for Prescription Drug Encounter (PDE) Data in 2024
The Centers for Medicare & Medicaid Services (CMS) has been processing Part D drug claim data via the Drug Data
Navigating the 2025 Advance Notice: Implications for Medicare Advantage and Part D
On January 31, 2024, the Centers for Medicare & Medicaid Services (CMS) released a draft of the 2025 Advance Notice
CMS Program and Focus Audits: Are You Prepared?
Updated October 2026: this post describes the CMS program audit protocols as of 2024. For current requirements, see 2026 CMS
Understanding the 2025 Medicare Part D Re-design: What You Need to Know
Updated October 2026: this post describes the Medicare Part D redesign as it took effect in 2025. The redesigned benefit
Preparing for 2024: Essential Compliance Checklist for Medicare Advantage Organizations
The Annual Election Period (AEP) has ended. Before the Medicare Advantage Open Enrollment Period (MA OEP)[1] begins on January 1, 2024,
Will Reporting Medical Loss Ratio (MLR) Constrain Payments to Medicare Advantage Plans?
Medicare Advantage plans (MAO) have been increasingly popular, with Medicare-eligible beneficiaries enrolling 51% of the eligible population in 2023, taking
Regulatory Changes for PDE Reporting in CY 2024 and Beyond
On October 13, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Readiness List for CY 2024. This
How Price Transparency in Healthcare Affects Providers, Payers and Patients
Price transparency is a term that has recently become a leading factor among healthcare payers and providers. It’s a tool