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Quality of Sponsor Data Used in Calculating Coverage-Gap Discounts

HHS is required to establish a Medicare coverage-gap discount program to provide relief to beneficiaries who are responsible for paying all drug costs during their coverage gaps (Social Security Act § 1860D14A, as amended by the Patient Protection and Affordable Care Act § 3301). Sponsors track beneficiary payment information and the drug cost data necessary to calculate eligibility for the program. We will review data submitted by Part D sponsors for use in calculating the coverage gap discount to assess the accuracy of the data and determine whether beneficiary payments are correct and amounts paid to sponsors are supported.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
October 2017 Centers for Medicare & Medicaid Services Quality of Sponsor Data Used in Calculating Coverage-Gap Discounts Office of Audit Services W-00-16-35611; W-00-17-35611; various reviews 2019