	Background

Medicare Part D coverage is provided through private sponsors that offer a  choice of PDPs with different costs and coverage. Characteristics of PDP Sponsors

For 2006, 79 sponsors are offering over 1,400 PDPs, each of which has  been approved by CMS to ensure that it meets established standards. CSRs Generally Provided Prompt, Courteous, and Helpful Service

Almost all of the calls we placed were answered by a CSR with minimal  delay. Further, we found that most CSRs with whom we spoke  were easy to understand, polite, and professional, and many provided  helpful suggestions and information. The  wait time to reach a CSR was generally short—46 percent of the 864 calls  CSRs fielded were answered in less than 1 minute and 96 percent of the  calls were answered in less than 5 minutes (see fig. Many CSRs also provided callers with helpful suggestions that related to  our questions. For example, during question 1 calls on the PDP  comparison for a low-utilization beneficiary, CSRs provided information  about a mail-order option to obtain drugs in 22 percent of the calls. PDP Sponsor Call Centers Did Not Consistently Provide Callers with Accurate and Complete Information

CSRs at the 10 PDP sponsor call centers we contacted provided accurate  and complete responses to about one-third of the calls they fielded,  although the accuracy and completeness rates for each of the 10 sponsor  call centers and for each of the five questions varied. CSRs were unable to  provide an answer for 15 percent of the questions posed, primarily those  related to plan costs. In addition, we found that CSRs within the same call  centers sometimes provided inconsistent responses to our questions. About One-Third of CSR Responses Were Accurate and Complete

Excluding the 4 percent of calls for which we did not reach a CSR, we  obtained accurate and complete responses to 34 percent of the calls—294  of 864—and obtained incomplete responses to another 29 percent of the  calls (see fig. The overall accuracy and completeness rates for each of the 10 PDP  sponsor call centers varied widely, ranging from 20 to 60 percent (see   fig. 3). In addition, in response to questions 1 and 2, CSRs at three call centers  told us that it was against the sponsor’s policies to identify any of their  plans as having the lowest annual cost. However, other CSRs at each of  these call centers did not cite this policy and did identify a plan as having  the lowest annual cost. Concluding Observations

Our calls to 10 of the largest PDP sponsors’ call centers show that  Medicare beneficiaries face challenges in obtaining the information  needed to make informed choices about the PDP that best meets their  needs. Call center CSRs are expected to provide answers to drug benefit  questions and comparative information about their sponsors’ PDP  offerings. In its comments, CMS characterized our analysis as based on inaccurate,  incomplete, and subjective methods that limit the report’s relevance and  validity. Furthermore, at a May 2006 meeting with CMS officials, the agency’s  Deputy Administrator stated that CSRs should be able to accurately  answer all of the specific questions we posed during the study. GAO staff who made contributions to this report are  listed in appendix II.
Why GAO Did This Study

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) established a voluntary outpatient prescription drug benefit, known as Medicare Part D. Private sponsors have contracted with the Centers for Medicare & Medicaid Services (CMS) to provide this benefit and are offering over 1,400 stand-alone prescription drug plans (PDP). Depending on where they live, beneficiaries typically have a choice of 40 to 50 PDPs, which vary in cost and coverage. MMA required each PDP sponsor to staff a toll-free call center, which serves as a key source of the information that beneficiaries need to make informed choices among PDPs. GAO examined (1) whether PDP sponsors provide prompt, courteous, and helpful service to Medicare beneficiaries and others and (2) the extent to which PDP sponsor call centers provide accurate and complete information to Medicare beneficiaries and other callers. To address these objectives, we made 900 calls to 10 of the largest PDP sponsor call centers during March 2006, posing one of five questions about their Part D plans during each call. We tracked the amount of time it took to reach a customer service representative (CSR), the number of calls that did not reach a CSR, and the appropriateness and clarity of CSRs' language. We developed criteria for determining accurate and complete responses based on CMS information.

What GAO Found

Call center service was generally prompt and courteous, and many CSRs offered helpful suggestions and information. GAO reached a representative in less than 1 minute for 46 percent of the calls CSRs fielded and in less than 5 minutes for 96 percent of the calls fielded. While GAO did not reach CSRs for 4 percent of the calls it placed, mainly because of disconnections, GAO found that 98 percent of CSRs with whom GAO spoke were easy to understand, polite, and professional. In addition, many CSRs provided helpful suggestions related to GAO's questions, such as details about a mail-order option to obtain drugs or lower-cost drugs. However, CSRs at 10 of the largest PDP sponsor call centers did not consistently provide accurate and complete responses to GAO's five questions, which GAO developed using information from CMS and other sources. GAO obtained accurate and complete responses to about one-third of the 864 calls for which GAO reached a CSR. The overall accuracy and completeness rate for each call center ranged from 20 to 60 percent. CSRs were unable to answer 15 percent of the questions posed, primarily those related to plan costs. Furthermore, CSRs within the same call center sometimes provided inconsistent answers. For example, in response to questions about PDP cost comparisons for specified sets of drugs, CSRs at 3 call centers told GAO that it was against the sponsors' policies to identify any of their plans as lowest cost. However, other CSRs at each of these call centers did not cite this policy and did identify a plan as lowest cost. In commenting on a draft of this report, CMS criticized the analysis as based on inaccurate, incomplete, and subjective methods that limit the report's relevance and validity. GAO maintains that its methods are sound and its findings are accurate. CMS officials told GAO at a May 2006 meeting that CSRs should have been able to accurately answer the questions GAO posed.