Medicare Part D: Time for a Checkup

Author:

Jordan Battani and Harold Horton

This white paper provides an overview of the Medicare Part D program as it enters its fourth year. The industry landscape and the emerging priorities from auditors and lawmakers provide clear direction in setting improvement targets and priorities for Part D plans. Operational excellence in enrollment processing and reconciliation continue to be high priority initiatives for Part D sponsors in order to optimize plan financial performance and because they are an increasing area of CMS audit scrutiny. Beneficiary grievance handling, resolution and reporting capabilities are also emerging as significant areas of concern for legislators, regulators and auditors. Recent legislation mandated claims operations improvements and plans would be wise to take steps to ensure that their operations, and those of their pharmacy benefit managers, are in compliance. Finally, recent rate reductions and cost scrutiny for Medicare Advantage programs, combined with continuing macroeconomic events, make cost transparency, efficiency and effectiveness very high priorities for Part D plan sponsors. The white paper offers directions for Part D drug plans in light of these changes and emerging opportunities.

Download "Medicare Part D: Time for a Checkup" (PDF 194KB)

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