Medicare Prescription Drug Benefit (Part D) Department of Health and Human Services

Medicare Prescription Drug Benefit (Medicare Part D) is a federal prescription drug benefit program for Medicare beneficiaries.

Agency Accountable Official: Ellen Murray, Assistant Secretary for Financial Resources

Program Accountable Official: Shantanu Agrawal, M.D., Deputy Administrator for the Center for Program Integrity, Centers for Medicare & Medicaid Services

Total Payments
$70.2B
Improper Payments
$2.4B
Improper Payment Rate
3.4%

Supplemental Measures

Current Measure: 1.19%

Target: 1.19%

Description: The Prescription Drug Event (PDE) validation process validates the prescription against the PDE data submitted to HHS for payment and is the major driver of error in Part D. The root cause shown under this annual supplemental measure is missing or illegible supporting documentation.

Update Frequency: Annually

Data Current as of: November 2016


Program Comments

In Fiscal Year (FY) 2016, HHS reported an error estimate for the Medicare Prescription Drug Program (Part D), based on Calendar Year 2014 payments.  The methodology for calculating the FY 2016 Part D error estimate has been revised from prior years, when HHS reported a Part D composite rate consisting of four components: Payment Error Related to Low Income Subsidy Status (PELS); Payment Error Related to Medicaid Status (PEMS); Payment Error Related to Prescription Drug Event Data Validation (PEPV); and Payment Error Related to Direct and Indirect Remuneration (PEDIR).

With OMB’s approval, for FY 2016 and subsequent years, the Part D error estimate measures only one component, the PEPV, which is the area where the majority of error for the program exists. The three other previously measured components – PELS, PEMS, and PEDIR - pose very little risk of payment error to the government. Over the years of measurement, the error estimates for these components as demonstrated in previous measurement cycles significantly decreased, such that the effort and resources required to measure them were no longer cost effective. A description of the previous methodology is in HHS's FY 2012 AFR. More information on this program can be found in the Department's Agency Financial Report.