Medicare Part D Compliance

The Centers for Medicare & Medicaid Services (CMS) oversees Medicare Part D plans. Drug companies contract with CMS to offer Part D plans to Medicare beneficiaries. Contracting with CMS requires adherence to strict guidelines that cover marketing and administration of Part D plans.

Enrollment

• Medicare beneficiaries can enroll into Part D plans only at certain times of the year. To remain in compliance, plans must report enrollments and disenrollments to Medicare.

Access to Prescriptions

• Plans must report pharmacy access to Medicare. Depending on the area the plan serves, this access can include long-term care providers and home health care providers. All Medicare beneficiaries must have access to the medicines they need, despite their personal situations.

Grievances and Appeals

• Plans must report any grievances received to Medicare, as well as the resolution to each grievance. Similarly, plans must report on their responses to requests for formulary exceptions and to beneficiary appeal requests.

Licensure and Business Practices

• Companies must track and report on the agents contracted to work with them. Agents must agree to abide by Medicare guidelines in marketing and selling Part D plans.