01/07/2014 Medicare Part D Coverage Gap Discount Program Program Dates Page 1 of 7
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1 01/07/2014 Medicare Part D Coverage Gap Discount Program Program Dates Page 1 of 7 and A. COVERAGE GAP DISCOUNT PROGRAM - BY CALENDAR YEAR 2011 through 2017 PDE Reporting Period Paid By After Receipt After APPS Offset Leap Dispute Submission Dispute Resolution Appeals Submission Appeals Resolution Admin Appeals 2011 Q1 3/31/2011 4/30/2011 5/1/2011 6/7/2011 6/14/2011 7/2011 6/30/2011 8/29/2011 9/28/ /21/2011 1/22/ Q2 6/30/2011 8/31/2011 9/1/ /9/ /17/ / /31/ /30/2011 1/29/2012 4/28/2012 5/28/ Q3 9/30/ /31/ /1/ /9/ /16/2011 1/ /31/2011 2/29/2012 3/30/2012 6/28/2012 7/28/ Q4 12/31/2011 1/31/2012 2/1/2012 3/10/2012 3/16/2012 4/2012 % 4/1/2012 5/31/2012 6/30/2012 9/28/ /28/2012 #2012 Q1 3/31/2012 5/8/2012 5/9/2012 6/22/2012 6/29/2012 6/2012 7/13/2012 9/11/ /11/2012 1/9/2013 2/8/ Q2 6/30/2012 8/31/2012 9/1/ /9/ /16/ / /31/ /30/2012 1/29/2013 4/29/2013 5/29/ Q3 9/30/ /31/ /1/ /9/ /14/ / /31/2012 3/1/2013 3/31/2013 6/29/2013 7/29/ Q4 12/31/2012 1/31/2013 2/1/2013 3/11/2013 3/18/2013 3/2013 4/2/2013 6/1/2013 7/1/2013 9/29/ /29/ Q1 3/31/2013 4/30/2013 5/1/2013 6/8/2013 6/14/2013 6/2013 6/30/2013 8/29/2013 9/28/ /27/2013 1/26/ Q2 6/30/2013 8/31/2013 9/1/ /9/ /16/ / /31/ /30/2013 1/29/2014 4/29/2014 5/29/ Q3 9/30/ /31/ /1/ /9/ /16/ / /31/2013 3/1/2014 3/31/2014 6/29/2014 7/29/ Q4 12/31/2013 1/31/2014 2/1/2014 3/11/2014 3/18/2014 3/2014 4/2/2014 6/1/2014 7/1/2014 9/29/ /29/ Q1 3/31/2014 4/30/2014 5/1/2014 6/8/2014 6/13/2014 6/2014 6/30/2014 8/29/2014 9/28/ /27/2014 1/26/ Q2 6/30/2014 8/31/2014 9/1/ /9/ /16/ / /31/ /30/2014 1/29/2015 4/29/2015 5/29/ Q3 9/30/ /31/ /1/ /9/ /16/ / /31/2014 3/1/2015 3/31/2015 6/29/2015 7/29/ Q4 12/31/2014 1/31/2015 2/1/2015 3/11/2015 3/18/2015 3/2015 4/2/2015 6/1/2015 7/1/2015 9/29/ /29/ Q1 3/31/2015 4/30/2015 5/1/2015 6/8/2015 6/15/2015 6/2015 6/30/2015 8/29/2015 9/28/ /27/2015 1/26/ Q2 6/30/2015 8/31/2015 9/1/ /9/ /16/ / /31/ /30/2015 1/29/2016 4/29/2016 5/29/ Q3 9/30/ /31/ /1/ /9/ /16/ / /31/2015 3/1/2016 3/31/2016 6/29/2016 7/29/ Q4 12/31/2015 1/31/2016 2/1/2016 3/10/2016 3/17/2016 3/2016 % 4/1/2016 5/31/2016 6/30/2016 9/28/ /28/ Q1 3/31/2016 4/30/2016 5/1/2016 6/8/2016 6/15/2016 6/2016 6/30/2016 8/29/2016 9/28/ /27/2016 1/26/ Q2 6/30/2016 8/31/2016 9/1/ /9/ /14/ / /31/ /30/2016 1/29/2017 4/29/2017 5/29/ Q3 9/30/ /31/ /1/ /9/ /16/ / /31/2016 3/1/2017 3/31/2017 6/29/2017 7/29/ Q4 12/31/2016 1/31/2017 2/1/2017 3/11/2017 3/17/2017 3/2017 4/2/17 6/1/2017 7/1/2017 9/29/ /29/ Q1 3/31/2017 4/30/2017 5/1/2017 6/8/2017 6/15/2017 6/2017 6/30/2017 8/29/2017 9/28/ /27/2017 1/26/ Q2 6/30/2017 8/31/2017 9/1/ /9/ /16/ / /31/ /30/2017 1/29/2018 4/29/2018 5/29/ Q3 9/30/ /31/ /1/ /9/ /15/ / /31/2017 3/1/2018 3/31/2018 6/29/2018 7/29/ Q4 12/31/2017 1/31/2018 2/1/2018 3/11/2018 3/16/2018 3/2018 4/2/2018 6/1/2018 7/1/2018 9/29/ /29/2018 Date the date the TPA sends the s to the manufacturer s mailbox. the day after the Date. Countdown to payment due, confirmation, dispute, and appeal dates begins on this date. Deadline last day for manufacturers to pay amounts invoiced to each contract. Occurs 38 calendar days after the Receipt date. Confirmation Deadline last day for the Manufacturers and Sponsors to confirm payment, 5 business days after the Deadline. Dispute Submission Deadline last day for manufacturers to submit disputes for the quarter, 60 calendar days after Receipt date.
2 01/07/2014 Medicare Part D Coverage Gap Discount Program Program Dates Page 2 of 7 Dispute Resolution Deadline last day for the TPA/CMS to respond to disputes filed for the quarter, 60 calendar days after the Dispute submission deadline date. Appeals Submission Deadline last day for the manufacturer to appeal denied disputes, 30 calendar days after the dispute resolution date. Appeals Resolution Deadline last day for the TPA/CMS to respond to appeals, 90 calendar days after the Appeals Submission date. Admin Appeals Deadline last day for the manufacturer to file a final appeal to previous denials for the quarter, 30 calendar days after the Appeals Resolution deadline Date. After 18 months from the beginning of a benefit year, spanning 6 quarterly invoices, offsets will end. *Dispute and Appeals deadlines listed are the latest possible date to submit the appropriate file. Files may be submitted earlier but subsequent deadlines should be adjusted accordingly, using the definitions above. **All dates are subject to change without notice. #Dates changed from original schedule.
3 01/07/2014 Medicare Part D Coverage Gap Discount Program Program Dates Page 3 of 7 B. COVERAGE GAP DISCOUNT PROGRAM - BY BENEFIT YEAR Calendar PDE Paid By After After APPS Offset Q1 Q1 3/31/2011 4/30/2011 5/1/2011 6/7/2011* 6/14/2011 7/2011 Q2 Q2 6/30/2011 8/31/2011 9/1/ /9/ /14/ /2011 Q3 Q3 9/30/ /31/ /1/ /9/ /16/2011 1/2012 Q4 Q4 12/31/2011 1/31/2012 2/1/2012 3/10/2012 3/16/2012 4/2012 #Q5 Q1 3/31/2012 5/8/2012 5/9/2012 6/22/2012 6/29/2012 6/2012 Q6 Q2 6/30/2012 8/31/2012 9/1/ /9/ /16/ /2012 Q7 Q3 9/30/ /31/ /1/ /9/ /14/2012 Q8 Q4 12/31/2012 1/31/2013 2/1/2013 3/11/2013 3/18/2013 Q9 Q1 3/31/2013 4/30/2013 5/1/2013 6/8/2013 6/14/2013 Q10 Q2 6/30/2013 8/31/2013 9/1/ /9/ /16/2013 Q11 Q3 9/30/ /31/ /1/ /9/ /16/2013 Q12 Q4 12/31/2013 1/31/2014 2/1/2014 3/11/2014 3/18/2014 Q13 Q1 3/31/2014 4/30/2014 5/1/2014 6/8/2014 6/13/2014 Q14 Q2 6/30/2014 8/31/2014 9/1/ /9/ /16/2014 Q15 Q3 9/30/ /31/ /1/ /9/ /16/2014 Q16 Q4 12/31/2014 1/31/2015 2/1/2015 3/11/2015 3/18/2015 Q17 Q1 3/31/2015 4/30/2015 5/1/2015 6/8/2015 6/15/2015 **All dates are subject to change without notice. #Changed from original First 4 quarters occur within the benefit year. Reconciliation occurs after quarter 6. After 18 months from the beginning of a benefit year, spanning 6 quarterly invoices, offsets will end. Final prospective payment for a benefit year occurs in January of the following year. PDE cutoff for coverage gap discount eligibility for benefit year 2012 is January 2015, and will be invoiced for Qtr All s are identified by the calendar quarter for which they were created. See Chart E for more information on /Calendar quarter overlap. EGWPs plans do not receive prospective payments therefore they are not subject to payment offsets.
4 01/07/2014 Medicare Part D Coverage Gap Discount Program Program Dates Page 4 of 7 C. COVERAGE GAP DISCOUNT PROGRAM - BY BENEFIT YEAR Calendar PDE Paid By After After APPS Offset #Q1 Q1 3/31/2012 5/8/2012 5/9/2012 6/22/2012 6/29/2012 6/2012 Q2 Q2 6/30/2012 8/31/2012 9/1/ /9/ /16/ /2012 Q3 Q3 9/30/ /31/ /1/ /9/ /14/ /2012 Q4 Q4 12/31/2012 1/31/2013 2/1/2013 3/11/2013 3/18/2013 3/2013 Q5 Q1 3/31/2013 4/30/2013 5/1/2013 6/8/2013 6/14/2013 6/2013 Q6 Q2 6/30/2013 8/31/2013 9/1/ /9/ /16/ /2013 Q7 Q3 9/30/ /31/ /1/ /9/ /16/2013 Q8 Q4 12/31/2013 1/31/2014 2/1/2014 3/11/2014 3/18/2014 Q9 Q1 3/31/2014 4/30/2014 5/1/2014 6/8/2014 6/13/2014 Q10 Q2 6/30/2014 8/31/2014 9/1/ /9/ /16/2014 Q11 Q3 9/30/ /31/ /1/ /9/ /16/2014 Q12 Q4 12/31/2014 1/31/2015 2/1/2015 3/11/2015 3/18/2015 Q13 Q1 3/31/2015 4/30/2015 5/1/2015 6/8/2015 6/15/2015 Q14 Q2 6/30/2015 8/31/2015 9/1/ /9/ /16/2015 Q15 Q3 9/30/ /31/ /1/ /9/ /16/2015 Q16 Q4 12/31/2015 1/31/2016 2/1/2016 3/10/2016 3/17/2016 Q17 Q1 3/31/2016 4/30/2016 5/1/2016 6/8/2016 6/15/2016 **All dates are subject to change without notice. #Dates changed from original. First 4 quarters occur within the benefit year. Reconciliation occurs after quarter 6. After 18 months from the beginning of a benefit year, spanning 6 quarterly invoices, offsets will end. Final prospective payment for a benefit year occurs in January of the following year. PDE cutoff for coverage gap discount eligibility for benefit year 2012 is January 2016, and will be invoiced for Qtr All s are identified by the calendar quarter for which they were created. See Chart E for more information on /Calendar quarter overlap. EGWPs plans do not receive prospective payments therefore they are not subject to payment offsets.
5 01/07/2014 Medicare Part D Coverage Gap Discount Program Program Dates Page 5 of 7 D. COVERAGE GAP DISCOUNT PROGRAM - BY BENEFIT YEAR Calendar PDE Paid By After After APPS Offset Q1 Q1 3/31/ /30/2013 5/1/2013 6/8/2013 6/14/2013 6/2013 Q2 Q2 6/30/2013 8/31/2013 9/1/ /9/ /16/ /2013 Q3 Q3 9/30/ /31/ /1/ /9/ /16/ /2013 Q4 Q4 12/31/2013 1/31/2014 2/1/2014 3/11/2014 3/18/2014 3/2014 Q5 Q1 3/31/2014 4/30/2014 5/1/2014 6/8/2014 6/13/2014 6/2014 Q6 Q2 6/30/2014 8/31/2014 9/1/ /9/ /16/ /2014 Q7 Q3 9/30/ /31/ /1/ /9/ /16/2014 Q8 Q4 12/31/2014 1/31/2015 2/1/2015 3/11/2015 3/18/2015 Q9 Q1 3/31/2015 4/30/2015 5/1/2015 6/8/2015 6/15/2015 Q10 Q2 6/30/2015 8/31/2015 9/1/ /9/ /16/2015 Q11 Q3 9/30/ /31/ /1/ /9/ /16/2015 Q12 Q4 12/31/2015 1/31/2016 2/1/2016 3/10/2016 3/17/2016 Q13 Q1 3/31/2016 4/30/2016 5/1/2016 6/8/2016 6/15/2016 Q14 Q2 6/30/2016 8/31/2016 9/1/ /9/ /14/2016 Q15 Q3 9/30/ /31/ /1/ /9/ /16/2016 Q16 Q4 12/31/2016 1/31/2017 2/1/2017 3/11/2017 3/17/2017 Q17 Q1 3/31/2017 4/30/2017 5/1/2017 6/8/2017 6/15/2017 **All dates are subject to change without notice. #Dates changed from original. First 4 quarters occur within the benefit year. Reconciliation occurs after quarter 6. After 18 months from the beginning of a benefit year, spanning 6 quarterly invoices, offsets will end. Final prospective payment for a benefit year occurs in January of the following year. PDE cutoff for coverage gap discount eligibility for benefit year 2013 is January 2017, and will be invoiced for Qtr All s are identified by the calendar quarter for which they were created. See Chart E for more information on /Calendar quarter overlap. EGWPs plans do not receive prospective payments therefore they are not subject to payment offsets.
6 01/07/2014 Medicare Part D Coverage Gap Discount Program Program Dates Page 6 of 7 E. BENEFIT YEAR QUARTER OVERLAP PDE Reporting Period Qtr Calendar Q1 3/31/2011 Q Q2 6/30/2011 Q2 Q3 9/30/2011 Q3 Q4 12/31/2011 Q4 Q5 Q1 3/31/2012 Q Q6 Q2 6/30/2012 Q2 Q7 Q3 9/30/2012 Q3 Q8 Q4 12/31/2012 Q4 Q9 Q5 Q1 3/31/2013 Q Q10 Q6 Q2 6/30/2013 Q2 Q11 Q7 Q3 9/30/2013 Q3 Q12 Q8 Q4 12/31/2013 Q4 Q13 Q9 Q5 Q1 3/31/2014 Q Q14 Q10 Q6 Q2 6/30/2014 Q2 Q15 Q11 Q7 Q3 9/30/2014 Q3 Q16 Q12 Q8 Q4 12/31/2014 Q4 Q17 Q13 Q9 Q5 Q1 3/31/2015 Q Q14 Q10 Q6 Q2 6/30/2015 Q2 Q15 Q11 Q7 Q3 9/30/2015 Q3 Q16 Q12 Q8 Q4 12/31/2015 Q4 Q17 Q13 Q9 Q5 3/31/2016 Q Q14 Q10 Q6 6/30/2016 Q2 Q15 Q11 Q7 9/30/2016 Q3 Q16 Q12 Q8 12/31/2016 Q4 Q17 Q13 Q9 3/31/2017 Q Q14 Q10 6/30/2017 Q2 Q15 Q11 9/30/2017 Q3 Q16 Q12 12/31/2017 Q4 Q17 Q13 3/31/2018 Q Q14 6/30/2018 Q2 Q15 9/30/2018 Q3 Q16 12/31/2018 Q4 Q17 3/31/2019 Q In the Medicare Part D Coverage Gap Discount Program we invoice accepted and validated PDEs on 4-quarter calendar year basis. s are generated based on the quarter end dates of March 31, June 30, September 30, and December 31. PDEs that are accepted and that are not pended will usually be invoiced for the quarter they were submitted. If a beneficiary fills a prescription on December 31 the PDE will not be submitted to CMS in time to be included on the 4 invoice. If the timely filing guidelines are followed and the PDE passes all edits it will be invoiced in 1 of the following calendar year. If there are data quality issues the PDE will be pended to the PDE Analysis Website for correction. All s are identified by the calendar quarter for which they were created; however, PDEs for a particular benefit year may appear on up to 17 quarterly invoices until PDEs for that benefit year are no longer accepted. So, for example, 2 of 2013 will contain accepted PDEs submitted between April 1 and June 30 of That quarter could also contain PDEs for benefit years 2011 and Q would be the 10 th quarter 2011 benefit year PDEs could be found on an invoice, and the 6 th quarter a 2012 benefit year PDE could appear. But in both cases the benefit year quarter is used as a reference, and the identifier for the invoice is 2013 Q2. **All dates are subject to change without notice.
7 01/07/2014 Medicare Part D Coverage Gap Discount Program Program Dates Page 7 of 7 C. EFT Update Timeline and PDE Updated EFT file distributed EFT File update cutoff 2012 Q1 3/31/ /20/ /25/2012 4/30/ Q2 6/30/ /17/ /25/2012 8/31/ Q3 9/30/ /17/ /25/ /31/ Q4 12/31/ /17/ /25/2013 1/31/ Q1 3/31/ /17/ /25/2013 4/30/ Q2 6/30/ /17/ /25/2013 8/31/ Q3 9/30/ /10/ /25/ /31/ Q4 12/31/ /10/ /25/2014 1/31/ Q1 3/31/ /10/ /25/2014 4/30/ Q2 6/30/ /10/ /25/2014 8/31/ Q3 9/30/ /10/ /25/ /31/ Q4 12/31/ /10/ /25/2015 1/31/ Q1 3/31/ /10/ /25/2015 4/30/ Q2 6/30/ /10/ /25/2015 8/31/ Q3 9/30/ /10/ /25/ /31/ Q4 12/31/ /10/ /25/2016 1/31/2016
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