What you need to know

Prime is continuing to assist plans and issuers in meeting their legal obligation to file with Centers for Medicare & Medicaid Services (CMS) an annual Gag Clause Prohibition Compliance Attestation (GCPCA). The GCPCA is a requirement added by the Consolidated Appropriations Act (CAA) of 2021. 

Prime is providing the sub-attestation which the plan/issuer — or its third-party administrator (TPA) — may rely upon to file the GCPCA on the CMS website.
 
Overview

For purposes of the GCPCA, a “gag clause” is a contractual term that directly or indirectly improperly restricts specific data and information that a plan or issuer can make available to another party. 

Gag clauses in this context might potentially be found in agreements between a plan or issuer and any of the following parties:  

• A health care provider
• A network or association of providers
• A TPA
• Another service provider offering access to a network of providers

The GCPCA was first required to be submitted to CMS no later than Dec. 31, 2023, with subsequent attestations being due by Dec. 31 for each year thereafter. For more information on the GCPCA process, visit the CMS website.

Prime has conducted a review of its standard contracts with pharmacies within our pharmacy network, including plans/issuers and concluded that these agreements do not contain prohibited “gag clauses." The legal obligation to file the GCPCA is with the plan/issuer, and not the pharmacy benefit manager (PBM). We are providing the sub-attestation which the plan/issuer (or its TPA) may rely upon to file the GCPCA on the CMS website. 

Questions

Please contact your Prime account team representative regarding Prime's sub-attestation of compliance or the GCPCA filing process.