Centers for Medicare and Medicaid (CMS) recently issued guidance setting its expectation that Medicare Part D sponsors make their standard contracting terms and conditions available to requesting pharmacies no later than September 15 of the year preceding the benefit year.1 Requested terms and conditions should be provided to pharmacies within two business days of the request. If a sponsor requires a pharmacy to execute a confidentiality agreement before receiving the terms and conditions, that confidentiality agreement must be provided to the pharmacy within two business days of the request. The terms and conditions must then be provided within two business days of the sponsor’s receipt of the confidentiality agreement. Also, sponsors are directed to clearly identify the avenue through which interested pharmacies should make their request (e.g., phone number, e-mail address, website).
CMS indicates that the guidance was prompted by recent reports it received from pharmacies describing issues with sponsors’ contracting processes, including the transparency and timing. CMS reasoned that because sponsors should have “standard terms and conditions readily available by September 15, there is no justification for a delay in responding to a pharmacy’s AWP [(“any willing pharmacy”)] request made after that date.” CMS warned that sponsors should not cause any undue delay in executing “agreements with eligible and interested pharmacies that would in effect discourage pharmacies from pursuing an AWP contract.” The guidance does not change the sponsor’s ability to ask pharmacies to demonstrate they are qualified to meet the plan sponsors’ standard terms and conditions before executing the contract.
1 CMS Compliance with Any Willing Pharmacy (AWP) Requirements, August 13, 2015 available at http://www.ncpa.co/pdf/any-willing-parmacy-guidance.pdf.