For most of 2013, at least 25 percent of contracts for the Medicare prescription drug benefit known as Medicare Part D had one or more plans suppressed from Plan Finder, the Medicare website seniors use to choose their drug plans, according to a new government report.
Additionally, from 2009 to July 31, 2013, the Centers for Medicare and Medicaid Services (CMS) made more than 150 official compliance actions against plans for pricing inaccuracy by issuing 89 notices of noncompliance and 67 warning letters, according to the Government Accountability Office study, CMS Has Implemented Processes to Oversee Plan Finder Pricing Accuracy and Improve Website Usability. Medicare Part D is a federal program subsidizing the costs of prescription drugs for Medicare beneficiaries.
“Seniors should always have the right information when choosing a prescription drug plan,” said Senate Special Committee on Aging Chairman Bill Nelson (D-FL), who requested the report with the committee’s top Republican, Sen. Susan Collins of Maine. “This report underscores the need for Medicare to continue to do everything it can to stop false information from being posted on Plan Finder.”
CMS this year plans to add a “display” quality measure that will indicate the extent to which point-of-sale prescription drug costs were lower than prices posted on the plan finder.
There has been only one instance when CMS required a Part D plan sponsor to develop and implement a corrective action plan for compliance concerns related to Plan Finder pricing accuracy.
CMS requires Part D plan sponsors to submit accurate drug pricing information, which the agency uses to give seniors an online estimate of each plan’s annual drug costs and out-of-pocket expenses. When a plan is suppressed from the Plan Finder website, its pricing information is removed and beneficiaries are unable sign up for the plan on site until the sponsor submits accurate prices.
In cases where plan sponsors repeatedly submit false or incomplete information, CMS can issue noncompliance notices or warning letters. In more egregious cases, CMS can require plan sponsors to take corrective action or seek enforcement actions such as civil penalties, payment suspensions or contract terminations.
cheatsheet, Clinical Quality and Quality Care Delivery, Facts and Figures, Health and Wellness, Managed Risk, Medication Management
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