Group Plan >>EGWP and RDS Audits

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