Performance Improvement 2009. Do Prescription Drug Plans Accurately Track Beneficiaries' Out-of-Pocket Costs?


This study reviewed the processes that Part D plans and the Coordination of Benefits Contractor uses to help ensure the accurate tracking and oversight of beneficiaries’ true out-of-pocket costs. Part D plans are responsible for tracking these costs.

The study found that information on Part D plan enrollees’ additional prescription drug coverage was not consistently submitted in 2006; that Part D plans cited problems with transferring true out-of-pocket balances when enrollees changed plans; and that the Centers for Medicare & Medicaid Services had conducted limited oversight of Part D plans tracking of true out-of-pocket costs. CMS will continue the Part D plans’ self-attestation process, enforcing compliance with data-sharing agreements.

Report Title: Tracking Beneficiaries' True Out-of-Pocket Costs for the Part D Prescription Drug Benefit
Agency Sponsor: OS-OIG, Office of Inspector General
Federal Contact: Erin Lemire, 202-205-9523
Performer: Staff; Office of Inspector General
PIC ID: 8986

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"PerformanceImprovement2009.pdf" (pdf, 1.26Mb)

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