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Ensuring Dual-Eligible Beneficiaries' 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, plan sponsors have the 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 Affordable Care Act (ACA), § 3313, requires OIG to conduct this review annually. This will be the eighth report issued.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
April 2018 Centers for Medicare & Medicaid Services Ensuring Dual-Eligible Beneficiaries' Access to Drugs Under Part D: Mandatory Review Office of Evaluation and Inspections OEI-05-18-00240 2018

Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201