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Review of Medicare Part D Prescription Drug Event Data for Schedule II Drugs at Humana Insurance Company

Humana Insurance Company did not have adequate controls to (1) prevent unallowable partial fills of Schedule II drugs and (2) ensure the accuracy of certain fields in the Prescription Drug Event (PDE) records submitted for Schedule II drugs as required by Federal regulations. We found that 16 of 53 judgmentally selected PDE records represented unallowable partial fills (there were no refills), and 29 of 64 judgmentally selected PDE records contained inaccurate data in certain fields when compared with the supporting documentation at the pharmacies. An additional two PDE records were missing pharmacy documentation, which prevented us from determining the accuracy of the data in the records.

Filed under: Center for Medicare and Medicaid Services