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OIG finds Part D drug rejections delay or deny care

09/25/2019 4:17 PM | Rebekah Francis (Administrator)

The Department of Health and Human Services Office of the Inspector General (OIG) released a report finding that Medicare Part D beneficiaries face avoidable steps that can delay or prevent access to prescribed drugs. Based on 2017 data, the report found that Part D insurers rejected millions of prescriptions presented at pharmacies, yet overturned 73 percent of drug-coverage denials when beneficiaries appealed. The OIG signaled that some of these rejections could have been avoided if the prescribed drugs were on the approved lists, met requirements, or received any required preapprovals. OIG recommends that CMS:

·     Improve electronic communication between Part D insurers and prescribers to reduce avoidable pharmacy rejections and coverage denials; 

·     Reduce inappropriate pharmacy rejections; 

·     Reduce inappropriate coverage denials; and

·     Provide beneficiaries with clear, easily accessible information about Part D insurer performance problems, including those related to inappropriate pharmacy rejections and coverage denials.


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