United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2008-01-22 monographic deposited born digital 47 p. GA 1.13:GAO-08-47 https://www.govinfo.gov/app/details/GAOREPORTS-GAO-08-47 P0b002ee18039c7d0 f:d0847 DGPO 2010-08-12 2011-03-24 GAOREPORTS-GAO-08-47 machine generated eng fdlp REPORT GAOREPORTS-GAO-08-47 GAO-08-47 Data integrity Health care programs Health insurance Health policy Insurance claims Medicare Noncompliance Performance management Prescription drugs Program evaluation Program management Reporting requirements Policies and procedures Medicare Part D Other Written Product A79970 Under the Medicare Part D program, prescription drug coverage is provided through plans sponsored by private companies. Beneficiaries, their appointed representatives, or physicians can ask sponsors to cover prescriptions restricted under their plan--a process known as a coverage determination--and can appeal denials to the sponsor and the independent review entity (IRE). GAO was asked to review (1) the processes for sponsors' coverage determination decisions and the approval rates, (2) the processes for appealing coverage denials and the approval rates at the sponsor and IRE levels, and (3) the Centers for Medicare & Medicaid Services' (CMS) efforts to inform the public about sponsors' performance and oversee sponsors' processes. GAO visited seven sponsors that account for over half of Part D enrollment. GAO also interviewed and obtained data from CMS and IRE officials. https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-08-47/html/GAOREPORTS-GAO-08-47.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-08-47/pdf/GAOREPORTS-GAO-08-47.pdf GAO-08-47 https://www.govinfo.gov/app/details/GAOREPORTS-GAO-08-47 Other Written Product GAO-08-47; Medicare Part D: Plan Sponsors' Processing and CMS Monitoring of Drug Coverage Requests Could Be Improved; Data integrity Health care programs Health insurance Health policy Insurance claims Medicare Noncompliance Performance management Prescription drugs Program evaluation Program management Reporting requirements Policies and procedures Medicare Part D Volume 117 Page 2066 117 Stat. 2066 Public Law 108-173