Request for Information Medicare Transaction Facilitator (MTF) for the Medicare Drug Price Negotiation Program

Background: The Centers for Medicare & Medicaid Services (CMS) is issuing this Request for Information (RFI) to conduct market research for the availability and potential technical ability of healthcare-related organizations to provide Medicare Transaction Facilitator (MTF) services as part of the Medicare Drug Price Negotiation Program. The program aims to reduce federal government spending on prescription drugs and out-of-pocket drug costs for people with Medicare. The RFI provides background information on the Inflation Reduction Act (IRA), which requires HHS to negotiate prices for certain high-cost drugs covered under Medicare Part B and Part D. CMS created the Medicare Drug Rebate and Negotiations Group (MDRNG) to implement the IRA's Negotiation Program. The RFI seeks input on the functionalities and design of an MTF, including data exchange, customer support, and payment facilitation functions.

Details: The work details include the high-level proposed MTF data flows/processes.

CMS envisions that the MTF will collect prescription claims-level data from Part D plan sponsors and/or other entities, validate claim information, calculate pharmacy reimbursement owed by manufacturers, send aggregated data to dispensers and manufacturers, manage manufacturer to dispenser fund balances, send electronic remittance advices (ERAs) to pharmacies and dispensers, oversee electronic funds transfer automated clearing house (EFT ACH) payments to pharmacies and dispensers, invoice manufacturers, create and maintain databases of pending and finalized claims processed, create and transmit claim files to each dispenser and manufacturer, monitor ACH payments, generate reports, maintain a help desk for inquiries, etc.