Don’t Forget About Reporting Medicare Prescription Drugs To CMS | Fisher phillips


Most employers who offer plans that include prescription drug coverage are well aware of the requirement to notify individuals of the honorable status of this coverage by October 15 of each year. However, many are unaware that the Medicare Prescription Drug Improvement and Modernization (MMA) Act 2003 also states that employers offering prescription drug coverage must alert the Centers for Medicare & Medicaid Services ( CMS) at least once a year to find out whether the coverage is credible or non-credible. Here are a few reminders about this little-known compliance obligation.


Plan sponsors must provide the required coverage disclosure to CMS each year no later than 60 days after the start of a new plan year. Thus, calendar year plan sponsors have until March 1 to report to CMS. Plan sponsors must also notify CMS within 30 days of the termination of the plan or drug coverage or the change in coverage status.

CMS Portal

Plan sponsors should use CMS’s Credible Coverage Portal to complete the necessary Credible Coverage Disclosure Form. There is no paper alternative to meeting this disclosure requirement absent one of the few narrow exceptions. The good news is that the CMS portal includes helpful hyperlinks to agency tips and also has step-by-step instructions to help streamline reporting.


Many plan sponsors are concerned about other issues such as the ACA and W-2 reports after the start of the year. Additionally, the number of member inquiries tends to increase after the start of a new plan year as open enrollment errors are reported. It is understandable that a simple obligation to comply can slip through the cracks. That’s why now is the time for plan sponsors with calendar year plans to set a recall and be prepared to disclose to CMS the credible or non-credible status of a prescription drug coverage. plan by March 1, 2022.


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