ECT’s systematic pharmacy drug evaluation systems have been designed to provide Employer Group Waiver Plan (EGWP) and Retiree Drug Subsidy (RDS) plan oversight and administration.

The systems provide for:

• Evaluation of all associated costs
• Review of the plan eligibility to ensure all members are reported to CMS correctly and the associated member premiums are collected.
• Reports for the oversight and administration challenges available include:

• Benefit administration review for compliance with CMS bid submission, including Transition Plan coverage and Wrap Plan limits
• Review of CMS reporting, including Prescription Drug Event (PDE) and Direct or Indirect Remuneration (DIR) data sets, to verify they accurately reflect paid claims utilization