Relevant to: All Part D Sponsors
Part D sponsors are responsible for ensuring that prescription drug coverage is adjudicated consistent with their CMS approved plan benefit design. The purpose of the Cost Sharing Administration Analysis (CSAA) is to evaluate whether Part D sponsors are adhering to this requirement. Many beneficiaries use published cost sharing levels to make plan selections and estimate annual drug costs. Thus, it can be significantly impactful if the cost sharing on a prescription drug claim is adjudicated incorrectly. Consistent with 42 CFR § 423.505(n)(1), CMS may determine that a Part D plan sponsor is out of compliance with a Part D requirement
when a sponsor fails to meet performance standards articulated in the Part D statutes, regulations, or guidance.