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2014 PDE Reporting and Calculations Guidance

CMS received questions regarding example 18, which provides a scenario in which an Employer Group Waiver Plan (EGWP) Prescription Drug Event (PDE) record is completely in the coverage gap phase but this same PDE would be a straddle claim if the plan was a defined standard benefit plan. Examples 18 and 19 capture this scenario; however, example 18 is in error. Example 19 is the correct way to populate the PDE. CMS has deleted example 18 since it is in error and if corrected would have been duplicative of the scenario in example 19. The updated guidance has been renumbered so what was previously example 19 is now example 18. The updated 2014 PDE Reporting and Calculations Guidance is now posted to the CSSC website and can be accessed at the link provided below. Questions about the updated document can be sent to CMS at PDEJan2011@cms.hhs.gov.

2014 PDE Reporting and Calculations Guidance