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Medicare Part B Marketing Regulations

Medicare, a federal program administered by the Centers for Medicare and Medicaid Services (CMS), provides health benefits to individuals aged 65 and older and those receiving end stage renal disease treatment. Medicare Part B provides coverage for a limited amount of drugs and biologics, including drugs prescribed by a physician, durable medical equipment drugs, and other drugs covered by statute.

  1. Average Sales Price Information

    • CMS regulations require manufacturers to submit information concerning the average sales price of Medicare Part B drugs or biologics. Along with average sales price data, manufacturers must include specific information on how the average sales price was formulated, including information about manufacturer rebates or discounts. Manufacturers must submit the average sales price information on a quarterly basis; penalties are assessed for late filings.

    Advertising and Promotional Activities

    • CMS allows private companies offering Medicare Part B plans to market their products to individuals using direct mail and radio, television and print advertisements. Although entities may engage in telemarketing, federal law prohibits entities from contacting individuals on the National Do Not Call Registry. Individuals interested in plan enrollment must directly contact the company to enroll, because regulations prohibit plan enrollment if a telemarketer initiated the phone call. Plan advertisements may not contain language suggesting the plan is Medicare approved or endorsed.

    Brokers

    • CMS regulations discourage commission-based compensation arrangements that provide incentives to enroll individuals in unneeded Medicare Part B plans. CMS encourages broker training and testing so that brokers may be knowledgeable concerning the Medicare plans they are selling. Under proposed Medicare rules, brokers would be trained and tested concerning the Medicare program and on Medicare plans being sold. Proposed rules also prohibit the purchase of meals for prospective enrollees and would also require that nominal promotional items be offered to all Medicare beneficiaries.

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