	Background

Medicare Part D was established by the Medicare Prescription Drug,  Improvement, and Modernization Act of 2003.beneficiaries have been able to obtain prescription drug coverage through  prescription drug plans offered by Part D plan sponsors that contract with  CMS. Under these plans, monthly premiums  and cost-sharing arrangements can vary. 2). In addition to the website, customer service representatives for   1-800-MEDICARE—a nationwide toll-free telephone help line that  beneficiaries and their advisers can call to ask questions about  Medicare—also use a version of Plan Finder to provide information on  Part D plan options and to enroll beneficiaries over the phone. CMS Oversight of the Part D Program

CMS is responsible for overseeing plan sponsors’ compliance with their  Part D contracts. CMS collects performance data on Part D plans covered  under each individual contract for 18 quality measures—including a  measure for Plan Finder drug pricing accuracy. CMS Uses Data Checks and Quality Measures to Oversee Plan Finder’s Drug Pricing Accuracy and Has Taken Compliance Actions against Plan Sponsors

To assess the accuracy of pricing information on Plan Finder, CMS  performs computerized data checks on pricing information before it is  displayed on Plan Finder and has taken compliance actions against  certain Part D plan sponsors for submitting inaccurate and incomplete  pricing information. CMS requires Part D plan sponsors to submit drug pricing  information for their plans on a biweekly basis—which Plan Finder uses to  estimate beneficiaries’ cost-sharing amounts and expected drug costs. If CMS’s data checks identify potentially inaccurate plan pricing  information, CMS notifies the sponsor of the plan and gives the sponsor  an opportunity to attest to the accuracy of the data, or correct it. If the  sponsor does not verify or correct the pricing information, CMS will  “suppress” the plan from Plan Finder for two weeks, or longer if the  sponsor does not provide accurate pricing information for the next  biweekly data update. When a Part D plan is suppressed from Plan  Finder, its pricing information is removed and beneficiaries cannot enroll  in the plan through the website. 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 (see table 1). noncompliance and 67 warning letters for inaccurate or incomplete drug  pricing information. CMS’s processes for overseeing the accuracy of drug pricing information  in Plan Finder are consistent with internal control standards for the federal  government. CMS Uses Quality Measures to Evaluate Pricing Accuracy

CMS’s Star Ratings, which provide beneficiaries with information on plan  quality, assigns scores to each Part D contract on the accuracy of pricing  information on Plan Finder. To determine the annual quality ratings for  drug pricing accuracy, CMS compares Plan Finder drug prices with  beneficiaries’ point-of-sale drug costs and assigns scores based on the  extent to which the point-of-sale costs were higher than prices posted on  Plan Finder. For the 2013 Star Ratings, 6 percent of contracts had  point-of-sale prices that were greater than Plan Finder prices by an  average of 4 percent or more. CMS Has Obtained Feedback on Plan Finder from a Variety of Sources and Has Taken Steps to Improve Usability

CMS has assessed the usability of Plan Finder by obtaining feedback  from a variety of sources and has implemented updates to the website to  improve usability. CMS has conducted user tests on the  usability of Plan Finder with beneficiaries, beneficiary advisers, and  SHIP counselors. A website survey. Website user data. CMS has implemented updates to the website on a quarterly basis and,  according to CMS officials, has used feedback on Plan Finder to address  identified issues and improve the website’s usability. For example, CMS  developed and added a “frequently asked questions” webpage to the  website in 2013 to help beneficiaries with frequently encountered issues. In addition, CMS has added filters to help beneficiaries compare  Part D plans and select plans that meet their needs. Officials from the beneficiary assistance organizations we spoke with  generally told us that Plan Finder helps beneficiaries compare Part D  plans and that the website’s usability has improved over time. Agency Comments

GAO provided a draft of this report to HHS.
Why GAO Did This Study

The Medicare prescription drug program, known as Medicare Part D, provides a voluntary outpatient prescription drug benefit for Medicare beneficiaries. Beneficiaries may choose Part D plans from among multiple plans offered by private companies--plan sponsors--that contract with CMS. Plans may differ in their premiums and cost-sharing arrangements, the drugs they cover, and the pharmacies they contract with to fill prescriptions. CMS developed the Medicare Plan Finder interactive website in 2005 as a tool to help beneficiaries compare Part D plans and identify plans that meet their needs. For Plan Finder to serve its intended purpose, beneficiaries and their advisers need to be able to obtain accurate drug cost information, understand plan options, and navigate the website effectively.
GAO was asked to review CMS's efforts to ensure that beneficiaries can use Plan Finder effectively. This report examines (1) how CMS oversees the accuracy of drug pricing information in Plan Finder; and (2) how CMS assesses the usability of Plan Finder and any steps CMS has taken to improve it. To conduct this work, GAO reviewed documentation detailing CMS's processes for overseeing Plan Finder pricing accuracy and obtained data on agency compliance actions. GAO also interviewed CMS officials and organizations that help Medicare beneficiaries navigate Plan Finder to learn about CMS's processes for obtaining feedback on Plan Finder's usability and steps the agency has taken to improve the website.

What GAO Found

The Centers for Medicare & Medicaid Services (CMS), the agency within the Department of Health and Human Services (HHS) that administers Medicare, uses data checks and quality measures to oversee the accuracy of Part D plan pricing information on the Plan Finder interactive website. Part D sponsors may have multiple contracts with CMS to provide drug coverage, with each contract covering one or more distinct Part D plans, and CMS is responsible for overseeing plan sponsors' compliance with their Part D contracts. CMS requires Part D plan sponsors to submit drug pricing information for their plans, which Plan Finder uses to estimate beneficiaries' cost-sharing amounts and expected annual drug costs. To ensure the accuracy of this information,
CMS performs computerized data checks on the pricing information for each plan to identify incomplete and potentially inaccurate data before information is displayed on Plan Finder. If CMS's data checks identify potentially inaccurate plan pricing information, CMS gives the plan's sponsor an opportunity to attest to the accuracy of the data, or correct it. If the plan's sponsor does not verify or correct potential inaccuracies identified by these checks, CMS will "suppress" the plan from Plan Finder, which means that the plan's pricing information is removed and that beneficiaries cannot enroll in the plan through the website. In the first seven months of 2013, 25 percent of Part D contracts had one or more plans suppressed from Plan Finder at least once. CMS has taken compliance actions against plan sponsors for repeated suppressions--between January 1, 2009, and July 31, 2013, CMS issued 89 notices of noncompliance and 67 warning letters.
CMS uses quality measures to evaluate the accuracy of pricing information on Plan Finder. As part of its Part D Star Ratings, which provide beneficiaries with information on plan quality, CMS collects performance data on Part D plans covered under each individual contract. CMS assigns scores to each contract based on the extent to which beneficiaries' point-of-sale costs were higher than prices posted on Plan Finder. For the 2013 Star Ratings, 6 percent of contracts had point-of-sale prices that were greater than Plan Finder prices by an average of 4 percent or more.
CMS has assessed the usability of Plan Finder by obtaining feedback from a variety of sources, including beneficiary assistance organizations, user testing, a website survey, and website user data. CMS has used feedback on Plan Finder to update the website and improve usability. For example, CMS developed and added a "frequently asked questions" webpage to the website. Officials from the beneficiary organizations GAO spoke with generally said that Plan Finder helps beneficiaries compare Part D plans and that its usability has improved over time.