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CMS Guidance Clarifies Medicare Part D Dispensing Fees

CLEVELAND (December 16, 2021) – The Centers for Medicare & Medicaid Services (CMS) has issued guidance to clarify the definition of Medicare Part D pharmacy dispensing fees for the support of Medicare beneficiaries who live at home but require a more comprehensive level of pharmacy care, similar to the level provided in an institutional care setting. Click here to read the complete guidance from CMS.

This clarifying guidance recognizes the importance of specialized pharmacy services, such as medication delivery and special packaging, in supporting the overall health and wellbeing of Medicare beneficiaries with complex medical needs who want to age in place at home.

“This is great for Americans across the country who suffer from chronic conditions, as Medicare Advantage plans and Medicare Part D plans can rely upon this guidance to better provide care for their members,” said ExactCare President & CEO Dale Wollschleger, R.Ph. “ExactCare has been partnering with Medicare plans for over a decade to provide an enhanced level of pharmacy care exclusively to people with complex medical needs. We are pleased with this guidance from CMS and appreciate their work to clarify this increasingly important topic.”

A growing number of Americans are impacted by chronic conditions, with an estimated 171 million expected to be managing at least one chronic condition by the year 2030. This CMS guidance supports the enhanced care needs of this population, which often surpass services provided through traditional pharmacy models, and the resources required to provide this enhanced level of care.

Since 2009, ExactCare has been a pioneer in developing the long-term care at home pharmacy model, exclusively and only serving people who require institutional level of care needs regardless of their care setting—through transitions of care that take place between the home and facilities such as assisted living and long term care.

ExactCare collaborates with healthcare organizations—including health plans, home health, physicians, hospitals and other providers—to deliver this comprehensive level of pharmacy support, impacting nearly 100,000 people nationwide every year.

ExactCare is part of AnewHealth’s pharmacy solutions for complex care needs, optimizing medication therapy, mitigating medication-related risks, reducing unplanned healthcare utilization, and lowering the total cost of care.

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