GroundRules
42 CFR 423.2744: Prospective payments to Part D sponsors.
Where this section sits in the code
- Title 42—Public Health
- CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
- SUBCHAPTER B—MEDICARE PROGRAM
- PART 423—VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT
- Subpart AA—Medicare Part D Manufacturer Discount Program
(a) General rule. CMS will provide monthly prospective Manufacturer Discount Program payments to Part D sponsors for sponsors to advance manufacturer discounts as specified in § 423.2736(a) and reimburse network pharmacies as specified in § 423.2736(c).
(b) Exception. CMS will not provide prospective Manufacturer Discount Program payments to employer group waiver plans.
(c) Reconciliation. CMS will reconcile prospective Manufacturer Discount Program payments in accordance with subpart G of this part.
(d) Manufacturer bankruptcy. In the event that an agreement holder declares bankruptcy, as described in title 11 of the United States Code, and as a result of such bankruptcy does not pay the invoiced amounts described in § 423.2756(a), CMS will adjust the Manufacturer Discount Program reconciliation amount for affected Part D sponsors to account for the invoiced amounts owed for the contract year being reconciled. The Government reserves the right to file a proof-of-claim and take any other action under bankruptcy law, as appropriate, to attempt to recover such unpaid amounts and any civil money penalties imposed by CMS under this part.
Collected 2026-08-27T02:26:11Z. Source file · JSON