CGDP Reconciliation

Published 03/19/2024

The CGDP Reconciliation is a set of management reports from the Payment Reconciliation System (PRS). The Centers for Medicare & Medicaid Services (CMS) completes the calculations for the Part D Coverage Gap Discount (CGD) Reconciliation, which are performed in accordance with § 1860D-14A of the Social Security Act and associated regulations and guidance. The PRS reports specify the inputs and results of a specific payment reconciliation.

These reports contain sensitive financial information and provide data on Part D CGDP payment adjustments to remit and recover these calculated CGD reconciliation amounts by CMS for Part D Plan Sponsors.

There are two (2) reports that assist Part D Plan Sponsors with understanding the format of the information provided in the CGDP Reconciliation reports loaded to and made available for download in the CGDP PRS portal. These management reports detail the inputs and results of the CGDP reconciliation process for the specified coverage year.

The CGDP Reconciliation Inputs Report provides plans with beneficiary-level inputs received from the Medicare Advantage and Prescription Drug System (MARx) and the Drug Data Processing System (DDPS). This report displays the total dollar amount of Part D prospective CGDP payment and the total dollar amount of the Part D invoiced CGDP payment for the coverage year for each beneficiary enrolled in the plan. The CGDP Reconciliation Inputs Report allows plans to validate the beneficiary-level inputs received from DDPS and MARx that will be used in their CGDP Reconciliation.

The CGDP Reconciliation Results Report provides plans with all of the inputs needed to understand how their CGDP reconciliation is calculated; including plan-level and contract-level CGDP payment amounts and CGDP invoiced amounts. The calculation of the CGDP reconciliation subtracts the Coverage Gap Discount Payment Amount from the Coverage Gap Discount Invoiced Amount.

To request access to the Coverage Gap Discount Reconciliation Reports - Payment Reconciliation System (PRS), select and complete the PRS Form.

To access CGDP Reconciliation reports, select the Coverage Gap Discount Reconciliation Reports - Payment Reconciliation System (PRS) link. Only an authorized user with a CGDP Reconciliation User ID and password will be allowed to review and download these reports.

Note: A CGDP Portal User ID and password will not allow access to the CGDP Reconciliation reports.