Coverage Gap Discount Program Benefit Year Closeout Invoice Reports


The “Coverage Gap Discount Program Benefit Year Closeout Invoice Reports” have been distributed to the Pharmaceutical Manufacturers and Part D Sponsors via the CGDP Portal. As referenced in the CMS Memorandum titled “Coverage Gap Discount Program Benefit Year Closeout Invoice Reports”, these closeout reports will be released annually, approximately fifteen months after a benefit year’s Quarter 17 invoice receipt date. The Summary, Data, and Tracking reports released today, July 15th, are the first in an ongoing set of reporting to be furnished by the TPA.
 
A few important facts about these reports:
  • For this release, only Pharmaceutical Manufacturers and Part D Sponsors with upheld dispute activity that occurred in the Q17 benefit period received a report today. The Reimbursement Summary and Reimbursement Detail reports provide information on upheld disputes that occurred in the 17th quarter of a benefit year or adjustments to previously upheld disputes adjusted in the 17th quarter that resulted in a partial or full repayment of a gap discount amount that has not been previously invoiced.
  • Reports available on the Reports tab in the CGDP Portal will include Summary and Data reports for both Manufacturers and Sponsors which include only the last benefit year quarter dispute upheld activity (in this case 201117). An Upheld Tracking Dispute report will be available for Manufacturers. The purpose of this tracking report is to inform Manufacturers of any adjustment or deletion activity undertaken by the Sponsor in response to the upheld dispute. The Upheld Tracking Dispute report will include all upheld disputes that occurred in a benefit year with the history of the actions, or lack of action, taken on the PDE.
  • The file layouts for the Reimbursement Summary, Reimbursement Detail (Data), and Upheld Tracking Dispute reports are posted under the “References” section of the TPA website.
  • If you are a Part D Sponsor and you received an invoice, CMS requires you to pay the Pharmaceutical Manufacturer within 38 days of report distribution, resulting in a payment deadline of August 23, 2016.
  • The Benefit Year Closeout Payments should only be submitted via the CGDP portal.
  • The User Guides detailing instructions on these reports are located on the TPA website www.tpadministrator.com under the “References” section. Manufacturers should access the “Manufacturer Calendar Year (CY) Closeout Process” and the Sponsors should access the “Sponsor Calendar Year (CY) Closeout Process”.

For additional information, please refer to the “Coverage Gap Discount Program Benefit Year Closeout Invoice Reports” CMS memorandum released on May 2, 2016.  

If you have any questions, please contact the TPA at 1-877-534-2772, option 1 or by email at tpaoperations@tpadministrator.com.

Last Updated: 07/15/2016