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Medicare Drug Plans Have Not Met Requirements for Tracking Out-of-Pocket Costs

“DHS Inspector General Daniel R. Levinson announced today that the Office of Inspector General (OIG) for the Department of Health and Human Services found that Medicare drug plans have not met all requirements for tracking out-of-pocket spending by beneficiaries in the Medicare Part D prescription drug program. Accurate tracking of beneficiaries’ true out-of-pocket (TrOOP) costs is critical to ensuring appropriate cost sharing under the Part D program. TrOOP costs are the prescription drug expenditures that count toward the annual out-of-pocket threshold that beneficiaries must reach before catastrophic drug coverage begins. Yet in 2006, the Part D plans did not consistently meet requirements for reporting information to the Centers for Medicare & Medicaid Services (CMS) and its contractors and CMS conducted limited oversight of the process.”

  • Tracking Beneficiaries’ True Out-of-Pocket Costs for the Part D Prescription Drug Benefit (OEI-03-06-00360), December 2007
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