What role will private plans play in administering the new benefit?
The drug benefit will be administered by private health insurers, managed care organizations, and pharmacy benefit managers (PBMs), as specified by the MMA. CMS has created 34 regions, mostly state-based for plan sponsors providing a stand-alone drug benefit and 26 slightly larger regions for plans offering both drug and medical benefits. CMS designed the regions based on current insurance markets and state Medicare population levels.
