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Competitive Acquisition for Part B Drugs & Biologicals


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. 

Current CAP Activity:

An additional 2008 CAP physician election period concluded on February 15, 2008.

Bidding for 2009-2011 Approved CAP Vendor Contracts closed on February 15, 2008. For more information, please see the "Information for Bidders" page.

2008 CAP drug lists and payment amounts are posted in the downloads section of the Approved CAP Vendor page

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 pane near the top left of this page:

Information for Physicians- contains physician election updates and links to other resources, including billing tips, for CAP physicians and for physicians who are interested in participating in the CAP

Information for Bidders and CAP Bidder - Background contain information about the bidding process for approved CAP vendors

Regulations and Notices-describes the CAP's regulatory background

Approved CAP Vendor – provides contact information for the approved CAP vendor, appeals information, and links to drugs that are supplied under the CAP

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.


Section 303 (d) of the MMA [PDF 26KB]

CAP Training for Supplemental Insurance Companies [PDF 4.6MB]
Related Links Inside CMS

Competitive Acquisition for DMEPOS

Medicare Part B Drug Average Sales Price
Related Links Outside CMSExternal Linking Policy

CAP Designated Carrier (Noridian Administrative Services)


Page Last Modified: 09/10/2008 3:55:55 PM
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