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Ensuring Dual Eligibles’ Access to Drugs Under Part D – Mandatory Review

Dual-eligible beneficiaries are enrolled in Medicaid but qualify for prescription drug coverage under Medicare Part D. As long as Part D plans meet certain limitations outlined in 42 CFR § 423.120, they have discretion to include different Part D drugs and drug utilization tools in their formularies. We will review the extent to which drug formularies developed by Part D sponsors include drugs commonly used by dual-eligible beneficiaries, as required. The Patient Protection and Affordable Care Act, § 3313, requires OIG to conduct this review annually.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Nov-16 Centers for Medicare & Medicaid Services Ensuring Dual Eligibles’ Access to Drugs Under Part D – Mandatory Review Office of Evaluation and Inspections OEI-05-17-00160 2017

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