Medicare Pharmaceutical and Technology Ombudsman
We are pleased to announce that James Bailey is currently serving as the new Medicare Pharmaceutical and Technology Ombudsman, a role that was established by section 4010 of the 21st Century Cures Act to help support customer service and innovation in the Medicare program. This Ombudsman will receive, and look into, concerns and questions from pharmaceutical, biotechnology, medical device, diagnostic product manufacturers and other stakeholders regarding Medicare coverage, coding, and payment for products already covered or for which coverage is being sought. The Medicare Pharmaceutical and Technology Ombudsman will collaborate closely with our other Medicare program ombudspersons in the CMS Offices of Hearings and Inquiries.
In addition to helping stakeholders navigate the Medicare Program, the new Medicare Pharmaceutical and Technology Ombudsman is also interested in hearing about their experiences and sharing this information with others in CMS towards helping to promote transparency and predictability of the processes.
The Ombudsman does not duplicate or replace existing processes such as grievance procedures, appeals, judicial hearings, or other formal avenues stakeholders may access. However, the Ombudsman may look into how procedures were followed in these processes, and provide any feedback to others in CMS regarding what works well and opportunities for improvement. This Ombudsman cannot advocate for new coverage, coding or payment within the Medicare Program, but can facilitate information exchange.
James Bailey, Medicare Pharmaceutical and Technology Ombudsman
For People with Medicare
Medicare’s Pharmaceutical and Technology Ombudsman works with various manufacturers and other stakeholders regarding Medicare coverage, coding, and payment for pharmaceutical and medical technology products. Concerns or questions related to individuals with Medicare should be directed to 1-800-MEDICARE (1-800-633-4227) for assistance. TTY users can call 1‑877‑486‑2048. Additional information and assistance can also be found at the Medicare.gov website.