Non-substantive Memo

To: Jamie Wilson

Office of Information and Regulatory Affairs (OIRA)

Office of Management and Budget (OMB)

From: Kristy Kocot

Date: August 13, 2024

Subject: Non-Substantive Change Request – Medicare Advantage and Prescription Drug Programs: Part C and D Medicare Prescription Payment Plan Model Documents (OMB# 0938-1475)

This memo requests approval of non-substantive changes to the approved information collection, Medicare Advantage and Prescription Drug Programs: Part C and D Medicare Prescription Payment Plan Model Documents (OMB# 0938-1475).

Background

The Inflation Reduction Act (IRA) established the Medicare Prescription Payment Plan program, which requires MA Organizations offering Part D coverage and Part D sponsors to offer enrollees the option to pay their Part D cost sharing in monthly amounts spread out over the plan year. Under sections 1860D–2(b)(2)(E)(v)(III)(dd) and 1860D–2(b)(2)(E)(v)(III)(ee) of the Social Security Act (the Act), Part D sponsors must have a mechanism to notify a pharmacy when a Part D enrollee incurs out-of-pocket (OOP) costs with respect to covered Part D drugs that make it likely the enrollee may benefit from participating in the program and must provide that the pharmacy, after receiving such a notification, informs the enrollee about the program. Additionally, as outlined in the part two guidance for the Medicare Prescription Payment Plan, CMS is requiring Part D sponsors to undertake targeted outreach, both prior to and during the plan year, directly to Part D enrollees likely to benefit from the program.

To support Part D sponsors in meeting these requirements, CMS has developed a standardized notice for Part D enrollees identified as likely to benefit from the Medicare Prescription Payment Plan, the “Medicare Prescription Payment Plan Likely to Benefit Notice.” Part D sponsors are required to use this standardized notice to satisfy their obligation to perform targeted outreach to Part D enrollees who are identified as likely to benefit prior to and during the plan year, including those identified through the pharmacy notification process.

The collection was last approved by OMB on July 11, 2024, and expires on July 31, 2025

Overview of Requested Changes

OMB’s approval of this information collection package on July 11, 2024, occurred before the Centers for Medicare and Medicaid Services (CMS) was able to upload the final Medicare Prescription Payment Plan Likely to Benefit notice inclusive of the CMS form number and OMB control number. The other model documents in this information collection request package are linked on reginfo.gov but the final Likely to Benefit notice is not, and CMS has received multiple requests from stakeholders asking to access the final Likely to Benefit notice with the CMS form number and OMB control number on the dedicated OMB page. This non-substantive change request is to add the Likely to Benefit Notice, the Likely to Benefit Notice - Spanish Translation and Likely to Benefit Notice - Instructions to the ICR page on reginfo.gov. There are no other changes being made at this time and there are no program changes or burden adjustments.