Part D Plans Overview

Part D Plans must correctly calculate the TrOOP amount to properly adjudicate beneficiary claims, and to communicate this information to plan enrollees. To calculate TrOOP, Part D plans will have to determine if other entities have made payments on covered drugs, and whether such payments fall under the legal definition of incurred costs (as described in 42 CFR §423.100).

The Transaction Facilitator sends record of payment from payers supplemental to Part D to the Part D plan (in the form of an N transaction) for purposes of tracking TrOOP in real time.

Part D plans are to process N Transactions real-time and appropriately apply the information to TrOOP. Where necessary, Part D Plans are to adjust claims when record of payment is received latently.

This section provides navigation to topics that are pertinent to Part D Plans and coordination of benefits with Supplemental Payers.