CMS Pub. 100-18, ch. 12, § 20

Set forth below is a list of waivers or modifications approved for PDP sponsors offering

employer/union sponsored group health plans. As noted above, as a condition of CMS

granting the particular waiver or modification, PDP sponsors must demonstrate that they meet

the criteria established by CMS as outlined in the specific waiver. For each waiver, CMS has

noted whether the waiver/modification applies to “800 Series” PDPs, Direct Contract PDPs,

or employer/union sponsored group health plan enrollments in individual PDPs. Each of

these waivers/modifications will automatically apply to those PDP sponsors approved to offer

EGWPs or individual plans that satisfy the applicable criteria; thus, they do not need to be

granted on an individual basis. However, some waivers may be restricted to particular kinds

of entities and/or a particular set of circumstances as noted below.

In addition to the waivers that have been granted, PDP sponsors have the ability to request

additional waivers or modifications of Part D requirements on a case-by-case basis. If a

waiver or modification is granted, it will apply to all similarly situated entities. Details on

how to request additional waivers or modifications can be found in Appendix IV.