Rainmakers Awarded Centers for Medicare and Medicaid Services Part D Formulary Prior Authorization (PA) and Step Therapy (ST) Review Contract

Oct 29, 2020

Rainmakers Strategic Solutions LLC (Rainmakers) was awarded the Part D Formulary Prior Authorization (PA) and Step Therapy (ST) Review contract from the Centers for Medicare and Medicaid Services (CMS) to provide technical and clinical support for the Medicare Part D Prescription Drug Benefit. The addition of a prescription drug benefit to Medicare, via the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, represented a landmark change to the Medicare program and was designed to significantly improve the health care coverage available to millions of Medicare beneficiaries. The drug benefit, which began January 1, 2006, is offered to Medicare beneficiaries through Medicare Advantage drug plans (MA-PDs) and stand-alone prescription drug plans (PDPs).

“The opportunity to continue our Part D review work with the Center for Medicare and Medicaid Services that began in 2017 is an honor,” said Denise Rainey, President & CEO of Rainmakers Strategic Solutions. “We are committed to working with CMS to ensure Medicare beneficiaries receive optimal medication therapy without having to overcome significant barriers to coverage.”

For this project, Rainmakers will assist CMS in reviewing PA and ST utilization management criteria submitted by the Part D plans to ensure best practices and compliance with Chapter 6 of the Medicare Prescription Drug Benefit Manual. Rainmakers pharmacist reviewers and data analyst will conduct PA and ST criteria reviews and provide CMS with technical assistance and operational support during the annual and monthly review periods. The monthly reviews will also address reviews for PA and ST new and updated criteria.

Rainmakers has extensive knowledge and understanding of the MMA of 2003 and the Medicare Prescription Drug Benefit Manual from many years working on the CMS Part D Formulary and Benefits Review contract. Rainmakers pharmacists conducted over 5 million Part D PA and ST criteria reviews under our prior project term from 2017-2020 and have seamlessly been performing Part D PA and ST criteria reviews since. Our project leadership and pharmacists offer additional depth of understanding from conducting these types of reviews since 2007 under prior contract iterations.

About Rainmakers Strategic Solutions

Rainmakers Strategic Solutions LLC (Rainmakers) is a certified 8(a), economically disadvantaged woman-owned small consulting firm, founded in 2007 to provide expertise and highly practical solutions in support of the government and commercial sectors. Rainmakers’ principals are respected professionals with demonstrated success for clients facing evolving requirements and constituent needs. We develop, implement, and improve programs by applying insightful methodologies and delivering innovative results that address and simplify complex issues, streamline processes, and reduce costs. We have a genuine focus on achieving and maintaining an impeccable business relationship with our customers and supporting them in their efforts to improve processes. Client satisfaction is our most valuable asset and exceeding our customers’ expectations is our primary goal. For more information about our key cornerstones – excellence, passion, diversity, and knowledge – visit www.rainmakerssolutions.com, call (443) 348-8067 or connect with us on our social media channels:

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