Medicare Compliance & Reimbursement

Proposed reg would release Part D claims data to federal agencies and researchers.

A new proposed rule, which the Centers for Medicare & Medicaid Services (CMS) posted on the Oct. 17 Federal Register, would allow the agency to share Medicare Part D claims data with other federal agencies and researchers to use in studies.

Researchers would use the drug-claims data along with other Medicare data, such as patient hospitalizations and physician visits, CMS said in a recent request for comments on the proposed rule.

The agency assures that the Part D claims data would have the appropriate privacy protections and safeguards under the Health Insurance Portability and Accountability Act, but CMS wants the public's opinions on whether it should "consider additional regulatory limitations for external researchers in order to further guard against the potential misuse of data for non-research commercial purposes."

According to CMS, the proposed regulation would allow CMS and the Department of Health and Human Services to use Part D claims data to:

1) "Report on and evaluate the impact of drug use in the Medicare prescription drug program, including the interaction between prescription drug coverage and the services and utilization under traditional Medicare (Parts A & B) and the Medicare Advantage Program (Part C)"; and

2) "Conduct demonstration projects to evaluate the impact of drug coverage and make recommendations for improving the economy, efficiency, or effectiveness of the Medicare program." "Through the appropriate use of the new prescription drug claims data, we have an unprecedented resource to help us learn more about prescription drug usage by seniors and how we can help seniors get the most benefit from prescription drugs," CMS administrator Mark McClellan said in a recent statement.

CMS will accept comments on the proposed rule until Dec. 18, 2006. To read more about the proposed rule, view www.cms.hhs.gov/apps/media/press/release.asp?Counter=2036.