Medicare Part D Prescription Drug Coverage: Federal Oversight of Reported Price Concessions Data
DIANE Publishing, 2010 - 16 pages
The outpatient prescription drug benefit known as Medicare Part D was first available in Jan. 2006, and that year it provided federally subsidized prescription drug coverage for nearly 28 million beneficiaries at a cost of $47.4 billion -- almost 12% of total Medicare spending. Part D sponsors -- entities that enter into contracts with Medicare -- administer the benefit and compete for beneficiary enrollment. To provide coverage, the sponsors enter into contractual relationships with pharmacy benefit managers, drug manufacturers, and retail pharmacies. The Part D program relies on sponsors to generate prescription drug savings, in part through their ability to negotiate price concessions, such as rebates and discounts, with these entities.
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169 financial audits 2006 financial audits According to CMS allocation method Annual DIR Reports audit plan auditors audits by October audits of program audits were delayed checks to identify CMS conducted checks CMS expects CMS officials acknowledged CMS’s oversight CMS’s target timeline contracts D sponsors defining and reporting delayed due drug manufacturers due to financial enrollees estimated price concessions evaluate the accuracy expect to complete fair market value financial constraints findings and conclusions HHS-OIG identify certain potential include price concessions interviewed CMS officials July 25 manufacturer rebates Medicare Advantage Medicare Part D officials expected Officials told outliers and questionable oversight activities Oversight Challenges CMS PBMs plan’s possible problems potential problems Prescription Drugs price concessions data Price Concessions Reports prior to payment prior to reconciling program year 2006 questionable data reported data reported DIR data reported price concessions reports include price September 2007 sponsors should allocate variation in contractual