Medicare Kept 25 Percent of Part D
Contracts Out of Plan Finder Due to Pricing Inaccuracy: GAO Report
Senate Special Committee on Aging
requested GAO study the shows Medicare’s watchdog actions
17, 2014 - A new Government Accountability Office (GAO) report released
last week found that during the first seven months of 2013, 25 percent
of Medicare Part D contracts had one or more plans suppressed from Plan
Finder, the Medicare website seniors use to choose their drug plans, due
to pricing inaccuracy, according to a news release from the Senate
Special Committee on Aging.
The GAO also found that between
January 1, 2009 and July 31, 2013, the Centers for Medicare and Medicaid
Services (CMS) had taken more than 150 official compliance actions
against plans for pricing inaccuracy- issuing 89 notices of
noncompliance and 67 warning letters.
The report was requested in April
by U.S. Sens. Bill Nelson (D-FL) and Susan Collins (R-ME), the chairman
and ranking member of the Senate Special Committee on Aging, amid
concerns over the reliability and usability of the Plan Finder website.
“Seniors should always have the
right information when choosing a prescription drug plan,” said Nelson.
“This report underscores the need for Medicare to continue to do
everything it can to stop false information from being posted on Plan
Finder. While I welcome the steps CMS plans to take this year to
improve pricing accuracy, I’m going to closely monitor their progress.”
"In order for the Plan Finder to
work, seniors must be able to get accurate drug cost information if they
are to understand their plan options and choose the plan that best suits
their needs,” Collins said.
“I am encouraged that the report
finds that CMS has taken steps to ensure the accuracy of this
information and urge the agency to continue to work to make sure seniors
are able to navigate the website effectively."
Key among the GAO’s findings:
• In 2012, 18 percent of Part D
contracts had one or more plans that were suppressed from Plan Finder at
least once, and, from January 1, 2013, through July 31, 2013, 25 percent
of contracts had one or more plans that were suppressed at least once.
• Between January 1, 2009 and
July 31, 2013, CMS issued 89 notices of noncompliance and 67 warning
letters for inaccurate or incomplete drug pricing information.
• According to CMS documents,
there has been only one instance in which CMS required a Part D plan
sponsor to develop and implement a corrective action plan for compliance
concerns related to Plan Finder pricing accuracy.
• For 2014, CMS plans to add an
additional “display” quality measure that will indicate the extent to
which point-of-sale prescription drug costs were lower than prices
posted on the plan finder.
According to the report, Part D
plan sponsors are required by CMS to submit accurate drug pricing
information, which the agency uses to give seniors an online estimate of
each plan’s annual drug costs and out-of-pocket expenses. When a plan
is suppressed from the Plan Finder website, its pricing information is
removed and beneficiaries are unable sign up for the plan on site until
the sponsor submits accurate prices.
In cases where plan sponsors
repeatedly submit false or incomplete information, CMS can issue
noncompliance notices or warning letters. In more egregious cases, CMS
can also force plan sponsors to take corrective action or seek
enforcement actions such as civil penalties, payment suspensions or
The report found nearly 24 million
beneficiaries were enrolled in Part D plans in January 2013. Last
year, CMS had 630 contracts with Part D plan sponsors who together
offered coverage through 2,660 stand-alone and Medicare Advantage drug
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