Are there requirements expected of Medicare Part D plans?
Yes, there are several. Plans must pass a portion of the value of negotiated discounts, including rebates, back to the beneficiary, and disclose the level of rebates and discounts to Centers for Medicare & Medicaid Services (CMS). In addition, the drug list must include drugs within each therapeutic category and class, and must not be perceived to discriminate against certain populations. Requirements with Medicare Part D include the procedures for resolving grievances and explanation of coverage. The process for enrollees to request exceptions to the tiered cost structure may include a request to cover a drug that is not in the drug list.
