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Ensuring Dual-Eligible Enrollees' Access to Drugs Under Part D: Mandatory Review

Dual-eligible enrollees-that is, people enrolled in both Medicaid and Medicare-receive prescription drug coverage under Medicare Part D. As long as Part D plans meet certain limitations outlined in 42 CFR § 423.120, Part D sponsors have discretion to include different Part D drugs in their formularies. As required under section 3313 of the Patient Protection and Affordable Care Act, we will conduct an annual study of the extent to which formularies used by Part D plans include drugs commonly used by dual-eligible enrollees. This study will focus on Part D plans' 2024 formularies.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
April 2024 Centers for Medicare and Medicaid Services Ensuring Dual-Eligible Enrollees' Access to Drugs Under Part D: Mandatory Review Office of Evaluation and Inspections OEI-05-24-00210 2024