Review of Medicare Part D Prescription Drug Event Data for Schedule II Drugs at Hawaii Medical Service Association

摘要

As a Part D sponsor, Hawaii Medical Service Association (HMSA) provided prescription drug coverage to 119 beneficiaries and submitted to CMS 403 PDE records for Schedule II drugs for dates of service from January 1, 2008, through June 30, 2010. HMSA contracted with Argus Health Systems, Inc., through December 2009 and Medco Health Solutions, Inc., beginning January 2010 to provide PBM services, including claims processing and adjudication as well as preparation and submission of PDE records. Our objective was to determine whether HMSA had adequate controls to (1) prevent refills and unallowable partial fills of Schedule II drugs and (2) ensure the accuracy of certain fields in the PDE records submitted for Schedule II drugs.