Member Briefing - April 2007
Reimbursement to Medicare Part D Prescription Drug Plans
Paul Gelb, Esquire, Kaye Scholer LLP, Los Angeles, CA
Oscar Ramallo, Esquire, Kaye Scholer LLP, Los Angeles, CA
This Member Briefing describes the four methods CMS uses to reimburse Part D prescription drug plan sponsors: direct subsidy, low income cost-sharing subsidy, reinsurance subsidy, and risk sharing payments. The article explains the application of each reimbursement method to standard prescription drug plans, alternative and enhanced benefit plans, as well as demonstration plans. The Briefing also addresses the appeals process for reimbursement determinations.