§ 423.2263 General marketing requirements. Marketing is a subset of communications and therefore must follow the requirements outlined in § 423.2262 as well as this section. Marketing (as defined in § 423.2260) must additionally meet the following requirements: ( a ) Part D sponsors may begin marketing prospective plan year offerings on October 1 of each year for the following contract year. Part D sponsors may market the current and prospective year simultaneously provided materials clearly indicate what year is being discussed.
( b ) In marketing, Part D sponsors may not do any of the following: ( 1 ) Provide cash or other monetary rebates as an inducement for enrollment or otherwise.
( 2 ) Offer gifts to beneficiaries, unless the gifts are of nominal value (as governed by guidance published by the HHS OIG), are offered to similarly situated beneficiaries without regard to whether or not the beneficiary enrolls, and are not in the form of cash or other monetary rebates.
( 3 ) Provide meals to potential enrollees regardless of value.
( 4 ) Market non-health care related products to prospective enrollees during any Part D sales activity or presentation. This is considered cross-selling and is prohibited.
( 5 ) Compare their plan to other plans, unless the information is accurate, not misleading, and can be supported by the Part D sponsor making the comparison.
( 6 ) Display the names or logos or both of pharmacy co-branding partners on marketing materials, unless the materials clearly indicate via a disclaimer or in the body that “Other pharmacies are available in the network.”
( 7 ) Knowingly target or send unsolicited marketing materials to any Part D enrollee during the Open Enrollment Period (OEP). ( i ) During the OEP, a Part D sponsors may do any of the following: ( A ) Conduct marketing activities that focus on other enrollment opportunities, including but not limited to marketing to age-ins (who have not yet made an enrollment decision), marketing by 5-star plans regarding their continuous enrollment special election period (SEP), and marketing to dual-eligible and LIS beneficiaries who, in general, may make changes once per calendar quarter during the first nine months of the year;
( B ) Send marketing materials when a beneficiary makes a proactive request;
( C ) At the beneficiary's request, have one-on-one meetings with a sales agent;
( D ) At the beneficiary's request, provide information on the OEP through the call center; and
( E ) Include educational information, excluding marketing, on the Part D sponsor's website about the existence of OEP.
( ii ) During the OEP, a Part D sponsors may not: ( A ) Send unsolicited materials advertising the ability or opportunity to make an additional enrollment change or referencing the OEP;
( B ) Specifically target beneficiaries who are in the OEP because they made a choice during Annual Enrollment Period (AEP) by purchase of mailing lists or other means of identification;
( C ) Engage in or promote agent or broker activities that intend to target the OEP as an opportunity to make further sales; or
( D ) Call or otherwise contact former enrollees who have selected a new plan during the AEP.
( 8 ) Advertise benefits that are not available to beneficiaries in the service area(s) where the marketing appears, unless the advertisement is in local media that serves the service area(s) where the benefits are available and reaching beneficiaries who reside in other service areas is unavoidable.
( 9 ) Market any products or plans, benefits, or costs, unless the Part D sponsor or marketing name(s) as listed in HPMS of the entities offering the referenced products or plans, benefits, or costs are identified in the marketing material. ( i ) Part D sponsor or marketing names must be in 12-point font in print and may not be in the form of a disclaimer or in fine print.
( ii ) For television, online, or social media, the Part D sponsor or marketing name(s) must be either read at the same pace as the phone number or must be displayed throughout the entire advertisement in a font size equivalent to the advertised phone number, contact information or benefits.
( iii ) For radio or other voice-based advertisements, Part D sponsor or marketing names must be read at the same pace as phone numbers or contact information.
( 10 ) Part D sponsors may not include information about savings available to potential enrollees that are based on a comparison of typical expenses borne by uninsured individuals, unpaid costs of dually eligible beneficiaries, or other unrealized costs of a Medicare beneficiary.
( c ) The following requirements apply to how Part D sponsors must display CMS-issued Star Ratings: ( 1 ) References to individual Star Rating measure(s) must also include references to the overall Star Rating for MA-PDs and the summary rating for PDP plans.
( 2 ) May not use an individual underlying category, domain, or measure rating to imply overall higher Star Ratings.
( 3 ) Must be clear that the rating is out of 5 stars.
( 4 ) Must clearly identify the Star Ratings contract year.
( 5 ) May only market the Star Ratings in the service area(s) for which the Star Rating is applicable unless using Star Ratings to convey overall Part D sponsor performance (for example, “Plan X has achieved 4.5 stars in Montgomery, Chester, and Delaware Counties), in which case the Part D sponsor must do so in a way that is not confusing or misleading.
( 6 ) The following requirements apply to all 5 Star PDP contracts: ( i ) May not market the 5-star special enrollment period, as defined in § 423.38(c)(20), after November 30 of each year if the contract has not received an overall 5 star for the next contract year.
( ii ) May use CMS' 5- star icon or may create their own icon.
( 7 ) The following requirements apply to all Low Performing MA contracts: ( i ) The Low Performing Icon must be included on all materials about or referencing the specific contract's Star Ratings.
( ii ) Must state the Low Performing Icon means that the Part D sponsor's contract received a summary rating of 2.5 stars or below in Part D for the last 3 years.
( iii ) May not attempt to refute or minimize Low Performing Status.
[86 FR 6123, Jan. 19, 2021, as amended at 88 FR 22340, Apr. 12, 2023]