OIG Finds Part D Plans Cover Most Drugs Used by Dual Eligibles in 2026
The HHS Office of Inspector General reviewed Part D plan formularies for 2026 and found that plans generally include drugs commonly prescribed to dual-eligible beneficiaries. The analysis examined formulary coverage patterns for medications frequently used by individuals enrolled in both Medicare and Medicaid. The report provides insight into whether dual eligibles have adequate access to needed medications through Part D coverage. This matters for Medicaid managed care organizations that coordinate benefits for dually eligible members and must ensure continuity of pharmacy coverage across programs.
MCOs serving dual eligibles must coordinate Part D and Medicaid pharmacy benefits, and formulary adequacy directly affects care continuity, member grievances, and wraparound coverage obligations.
Pharmacy · Managed Care
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