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Provider Manual

Medicare Advantage Part D Data Submissions

Last Updated on August 28, 2018

Prescription drug event data - As a Medicare Advantage Part D plan, Security Health Plan is required to submit Part D drug claims data to CMS. For each Part D dispensing event, Security Health Plan shall submit a summary record called the prescription drug event (PDE) record to CMS. The PDE record contains prescription drug cost and payment data that will enable CMS to make payment to plans and otherwise administer the Part D benefit. Specifically, the PDE record will include covered drug costs above and below the out-of-pocket threshold; distinguish enhanced alternative costs from the costs of drugs provided under the standard benefit; and will record payments made by Part D plan sponsors, other payers, and by or on behalf of beneficiaries. Security Health Plan shall also identify costs that contribute towards a beneficiary’s true-out-of-pocket or TrOOP limit, separated into three categories: low-income cost-sharing subsidy amounts paid by the plan at the point of sale, beneficiary payments, and all TrOOP-eligible payments made by qualified entities on behalf of a beneficiary.