Competitive Acquisition for Part B Drugs & Biologicals

Current CAP Activity

Information about 2008 CAP claims submission deadlines and instructions about what to do with unused CAP drugs are posted on the Information for Physicians and Approved CAP Vendor pages.

The CAP has been postponed for 2009 and CMS is currently soliciting public feedback about the program.  Feedback can be submitted electronically at: MMA303DDrugBid@cms.hhs.gov.

For additional information on the 2009 CAP postponement, please see the text below or the Information for Physicians page.

2008 CAP drug lists are posted in the ‘Downloads' section of the Approved CAP Vendor page.

Feedback about the CAP: A Special Open Door Forum (ODF) Teleconference on the 2009 CAP Postponement and How to Submit E-mail Comments

The Centers for Medicare & Medicaid Services (CMS) is soliciting public feedback about the CAP. CMS is interested in hearing about a range of issues, including, but not limited to:

• the categories of drugs provided under the CAP
• the distribution of areas that are served by the CAP
• procedural changes that may increase the program's flexibility and appeal to potential vendors and physicians.

On December 3, 2008, CMS will host a Special ODF Teleconference to obtain feedback about the program. This teleconference will be a listening session and is intended for current and former participating CAP physicians, potential Approved CAP Vendors, and any other interested parties. CMS will assess the information that it receives as it considers implementing changes to the CAP.

Call Details:

Date and Time: December 3, 2008 from 2:00-3:30PM EST
Toll Free Call Number: (800) 837-1935
Conference ID: 66307647

Interested parties can also submit comments to the CAP e-mailbox at MMA303DDrugBid@cms.hhs.gov

September 18, 2008 Ask the Contractor Teleconference (ACT) PowerPoint Presentation

On September 18, 2008, CMS hosted an ACT for CAP physicians to discuss the postponement of the CAP for 2009 and to assist participating CAP physicians in planning for the transition out of the program. The ACT was moderated by Noridian Administrative Services (NAS), the CAP Designated Carrier.

The PowerPoint slide presentation for the ACT is available in the 'Training and Events' section on the NAS website. The NAS website can be accessed via the 'Related Links Outside CMS' section below.

2009 CAP Postponement

On September 10, 2008, the Centers for Medicare & Medicaid Services (CMS) announced the postponement of the 2009 Medicare Part B Competitive Acquisition Program (CAP).  The program will continue through December 31, 2008.

Earlier this year, CMS accepted bids for vendor contracts for the 2009-11 CAP.  While CMS received several qualified bids, contractual issues with the successful bidders resulted in CMS postponing the 2009 program.  As a result, CAP physician election for participation in the CAP in 2009 will not be held, and CAP drugs will not be available from an approved CAP vendor for dates of service after December 31, 2008.  

Later this fall, CMS will provide additional guidance for participating CAP physicians on how to transition out of the program. This information will be posted on the CMS CAP Physician's page.

CMS also plans to seek feedback on the CAP from participating physicians, potential vendors, and other interested parties. CMS will assess the information and consider implementing changes to the CAP before proceeding with another bid solicitation.  As part of the process, CMS is interested in hearing from the public about a range of issues, including, but not limited to, the categories of drugs provided under the CAP, the distribution of areas that are served by the CAP, and procedural changes that may increase the program's flexibility and appeal to potential vendors and physicians.

Information about how to submit comments will be available on this website. 

About the CAP:

Section 303 (d) of the Medicare Modernization Act (see Downloads section below) requires the implementation of a competitive acquisition program (CAP) for Medicare Part B drugs and biologicals not paid on a cost or prospective payment system basis. The CAP is an alternative to the ASP (buy and bill) methodology for acquiring certain Part B drugs which are administered incident to a physician's services.

Section 108 of the Medicare Improvements and Extension Act under Division B, Title I of the Tax Relief Health Care Act of 2006 (MIEA-TRHCA) amended Section 1847b(a)(3) of the Social Security Act and requires that CAP implement a post payment review process.  This procedure is done to assure that payment is made for a drug or biological under this section only if the drug or biological has been administered to a beneficiary.

In late 2005, CMS conducted the first round of bidding for approved CAP vendors. The CAP was implemented on July 1, 2006. 

Links to the following pages appear in the navigation panel near the top left of this page:

• Information for Physicians- contains the latest updates about the CAP, billing tips, the CAP drug list, and links to other resources for CAP physicians.
• Bidding Archive contains information about past approved CAP vendor bidding periods.
• Regulations and Notices- describes the CAP's regulatory background.
• Approved CAP Vendor – provides contact information for the 2006-2008 approved CAP vendor, appeals information, and CAP drug lists.

Noridian Administrative Services is the CAP designated carrier. Noridian is responsible for vendor enrollment, processing CAP drug claims, answering inquiries, and conducting dispute resolution. A link to Noridian's website appears in the Related Links Outside CMS section below.

Noridian Administrative Services, the designated carrier for the Medicare Part B Competitive Acquisition Program (CAP), has created a presentation about CAP for Supplemental Insurance Companies. This presentation includes information on the general background of CAP and how CAP affects claims submissions. The slides are available in the "Downloads" section of this page.