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

Announced on  | Last Modified on  | Project Number: OEI-05-26-00150
Status
Active
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

Dual-eligible enrollees are enrolled in both Medicaid and Medicare and 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 Medicare Part D plans include drugs commonly used by dual-eligible enrollees.  This study will focus on Part D Plans' 2026 formularies.

TIMELINE

  • February 17, 2026
    Announced
  • Today
    Office of Evaluation and Inspections In-Progress
  • Est FY2028
    Estimated Fiscal Year for Project Completion
Work Plan Type
Office of Evaluation and Inspections
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Prescription Drug
Target Groups
-
Financial Groups
Medicare D