This week's Advocacy Update includes information on NCPA members' political priorities for 2017; hearings on the Trump administration's HHS nominee; and the release of a Part D DIR analysis from CMS.

The Marketing Guidance on pharmacy/provider marketing activities applies to contracted pharmacies. This includes pharmacies which have entered into co-branding relationships with Plan Sponsors.

Providers must not steer, or attempt to steer, potential Part D Enrollees toward a specific plan or limited number of plans. Providers may assist a Part D Enrollee in an objective assessment of his/her needs and potential options to meet those needs. However, any assistance provided to a Part D Enrollee by a contractual, co-branded, or otherwise affiliated Provider, must result in a plan selection that is always in the best interest of the Part D Enrollee. Providers may engage in discussions with Part D Enrollees should a Part D Enrollee seek advice. However, Providers must remain neutral when assisting a Part D Enrollee with enrollment decisions.

*Please see attached PDF for more information.

As a reminder, Qualified Medicare Beneficiaries (QMBs), including some UnitedHealthcare Medicare Advantage members, are not responsible for any remaining balance after payment from Medicare for covered services. The Centers for Medicare & Medicaid Services (CMS) guidelines state that Medicare-contracted care providers may not collect cost-share from these patients.

To determine if you can bill Medicaid as the secondary payer, please review the information found in the Benefit Stage Qualifier field of the approved Medicare Advantage claim. Code 50 in that field indicates that the claim was paid under Part B benefits, even if the drugs were processed using a Part D Processor ID or control number. This is because Medicare Advantage, also known as Part C, combines Part A, Part B and Part D benefits. If this is the case and the member is an active QMB, you can bill the dollar amount found in the Qualifier Amount field to Medicaid.