What guidance is available to help a Retiree Drug Subsidy (RDS) Plan Sponsor determine whether a given drug is a Part D drug?
To determine whether a given drug is a Part D drug, RDS Plan Sponsors should first review the regulatory definition of a Part D drug found at 42 CFR ยง423.100. RDS Plan Sponsors may also wish to review the relevant provisions of Chapter 6 of the Medicare Part D Manual, which can be found at http://www.cms.hhs.gov/PrescriptionDrugCovContra/12_PartDManuals.asp#TopOfPage For three specific categories of drugs that might be either Medicare Part B eligible or Medicare Part D eligible, depending on how the drug was used/administered, CMS has published six different methods an RDS Plan Sponsor may use to extract Medicare Part B costs from RDS payment requests. That guidance document can be accessed by visiting http://www.cms.hhs.gov/EmployerRetireeDrugSubsid/01_Overview.asp and clicking on the link titled How to Extract Certain Medicare Part B Costs from RDS Payment Requests. RDS Plan Sponsors should not rely on the Formulary Reference NDC File to determine whether a given drug is a Part D dru
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