The Part D benefit constitutes perhaps the most significant change to the Medicare program since its inception in 1965. The addition of outpatient drugs to the Medicare program reflects Congress’ recognition of the fundamental change in recent years in how medical care is delivered in the U.S. It recognizes the vital role of prescription drugs in our health care delivery system, and the need to modernize Medicare to assure prescription drug availability to Medicare beneficiaries. Effective January 1, 2006, MMA established an optional prescription drug benefit, known as the Part D program, for individuals who are entitled to Medicare Part A and/or enrolled in Part B.
Regulatory compliance is not optional. Failure to comply with Medicare standards exposes a health plan to fines and potential loss of its Medicare Part D (“Part D”) contract. Non-compliance with regulatory standards undermines a health plan’s business reputation and credibility with its Medicare Part D members, employees, employer group and health plan clients, subcontractors, pharmacies and other health care providers.