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|