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, Part D plan sponsors 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 plan sponsors include drugs commonly used by dual-eligible beneficiaries as required. The Affordable Care Act, § 3313, requires OIG to conduct this review annually.

Announced or Revised	Agency	Title	Component	Report Number(s)	Expected Issue Date (FY)
Completed	Centers for Medicare and Medicaid Services	Ensuring Dual-Eligible Beneficiaries' Access to Drugs Under Part D: Mandatory Review	Office of Evaluation and Inspections	OEI-05-21-00170	2021