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OIG Posts New AO-07-05 and Report on Part D Prescription Plans

 

Email Alert

June 20, 2007

The OIG posted on June 19, 2007, a new Advisory Opinion to the website as well as a Report.

Access the Advisory Opinion document 07-05 (concerning a proposal for certain physician investors in an established ambulatory surgery center to sell a portion of their ownership interests to a local hospital).

See the index of recent OIG Advisory Opinions.

See Frequently Asked Questions (FAQs) on the OIG Advisory Opinion process.

Also, the OIG posted on June 19, 2007, a new report on Retail Pharmacy Participation in Medicare Part D Prescription Drug Plans in 2006 (OEI-05-06-00320).

According to the OIG, CMS requires stand-alone prescription drug plans to contract with a sufficient number of retail pharmacies to ensure that beneficiaries have access to retail pharmacies dispensing Part D-covered drugs. This report determines: (1) the extent to which retail pharmacies participate in Medicare Part D stand-alone prescription drug plans (PDPs), and (2) how many Medicare Part D stand-alone PDPs are offered by participating retail pharmacies.

The OIG found that nearly all retail pharmacies participate in Medicare Part D. Ninety-seven percent of retail pharmacies participate in at least one PDP. Furthermore, retail pharmacies in metropolitan and non-metropolitan counties participate at similarly high rates. Also, the OIG found that 70 percent of participating retail pharmacies offer beneficiaries the choice of all available PDPs in their region. Retail pharmacies in metropolitan and non-metropolitan counties offer beneficiaries the choice of all available PDPs at similarly high rates. Almost all independent and chain retail pharmacies offer beneficiaries the choice of at least half of the available PDPs.

The OIG's findings indicate that beneficiaries' access to retail pharmacies dispensing Part D-covered drugs does not appear to be limited by retail pharmacies' participation in PDPs. Although having fewer retail pharmacies located in an area may limit beneficiary access to retail pharmacies, the findings suggest that Part D does not further limit beneficiary access. In response to the OIG's draft report, CMS stated that it was pleased with the OIG's findings that beneficiary access to retail pharmacies dispensing Part D-covered drugs does not appear to be limited by retail pharmacies' participation in PDP networks. Additionally, CMS reiterated its commitment to ensuring that Part D beneficiaries have access to retail pharmacies.

We would like to thank Hal McCard (Chaffe McCall LLP, New Orleans, LA) for providing this email alert.

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