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DEPARTMENT OF HEALTH &. HUMAN SERVICES Office of Inspector General

OCT 1 7 2007 Washington, D.C. 20201

TO: Kerry Weems

Acting Administrator

Centers for Medicare & Medicaid Services

Daniel R. Levinson~ ¡: ~

Inspector General

FROM:

SUBJECT: Memorandum Report: Medicare Part 0 Prescription Drug Plan Sponsor

lnternet Web Sites: Content and Accessibility, OEI-06-06-00340

In November 2006, we notified the Centers for Medicare & Medicaid Services (CMS)

that we were beginning a study of "Medicare Part D Coverage Determinations"

(OEI-06-06-00340). Shortly afterward, the Offce ofInspector General (OIG) learned

that the Governent Accountability Office had undertaken a similar study. To avoid

duplication, OIG decided not to pursue the study at that time. However, in preparing to

perform the study, OIG identified issues with Medicare Part D Prescription Drug Plan

(PDP) sponsors' Internet Web sites that warranted further review.

This memorandum report provides information about Medicare Part D PDP sponsors'

Internet Web sites' compliance with Federal regulations regarding content and

accessibility. OIG examined the Web sites of all 84 POP sponsors offering drug plans

within the 50 States and the District of Columbia in 2007. i

Federal regulations require that all POP sponsors have Web sites that include specific

content about receipt and use of Medicare benefits.2 Further, each Federal department

and agency is required to ensure that individuals with disabilities have comparable access

to information as those individuals without disabilities.3 Additionally, the Medicare

Marketing Guidelines require Part D Plans to maintain Web sites that are compliant with

accessibility standards for people with disabilities.4

i We excluded POP sponsors with service areas only in Puerto Rico and U. S. territories and we did not

include Medicare Advantage Prescription Drug Plans.

242 CFR § 423.128(d)(2).

3 Section 508 of the Rehabilitation Act (29 U.S.c. § 794d), as amended by the Workforce Investment Act

of 1998 (P.L. 105-220), § 508(a)(I)(A)(ii).

4 CMS, "Medicare Marketing Guidelines for: Medicare Advantage Plans, Medicare Advantage Prescription

Drug Plans, Prescription Drug Plans, and 1876 Cost Plans." Available online at

http://www . c ms. h hs. go viP rescr i pti 0 n D rii gCovContra/Do wn load s/F ina IMarketingG 1I ide Ii n es. pd f. Accessed

August 16, 2006.
 

 

 

Page 2 – Kerry Weems 

We found that 33 percent of the 84 PDP sponsors’ Web sites we reviewed did not contain 

all federally required content. The most commonly omitted information pertained to 

enrollee disenrollment rights and responsibilities, the potential for PDP contract 

termination, and information related to the formulary. Using two electronic tools that 

allow page-level testing of Web-based information and applications, we also found that 

85 percent of sponsor Web sites did not meet at least one of the Federal requirements for 

Web site accessibility. These problems could affect access to content by Medicare 

beneficiaries. 

BACKGROUND 

Medicare Part D: Prescription Drug Benefit 

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 created 

the Part D program to provide access to prescription drug coverage for individuals 

eligible for Medicare.5 Beneficiaries have two options. The first option is to enroll in a 

PDP for their drug coverage and receive all other benefits through traditional Medicare 

fee-for-service. The second option is to enroll in a Medicare Advantage Prescription 

Drug Plan (MA-PD) and receive all Medicare benefits, including drug coverage, through 

managed care.6 Most of the beneficiaries enrolled in Medicare Part D as of May 2007 

(17 million of 25.4 million) were enrolled in PDPs.7 

Part D plan sponsors are nongovernmental entities under contract with CMS to offer 

prescription drug benefits through PDPs, MA-PDs, PACE plans, or cost plans offering 

qualified prescription drug coverage.8 9 In early 2007, there were 1,875 PDPs in the 

United States distributed among 84 plan sponsors.10 11 The number of Medicare 

beneficiaries enrolled in particular PDPs varies considerably. Four plan sponsors have 

more than a million enrollees each, 23 plan sponsors have between 100,000 and 999,999 

enrollees each, and 57 plan sponsors have fewer than 100,000 enrollees each.12 

Each Part D plan sponsor is required to have mechanisms for providing information to 

current and prospective enrollees. These mechanisms must include a toll-free customer 

5 Medicare Prescription Drug, Improvement, and Modernization Act of 2003, P. L. 108-173. 

6

 CMS, Final Rule, “Medicare Prescription Drug Benefit,” 70 FR 4194 (Jan. 28, 2005). 

7

 CMS, “CMS Medicare Advantage, Cost, PACE, Demo, and Prescription Drug Plan Organizations; 

Monthly Report by Contract, May 2007.” Available online at
 

http://www.cms.hhs.gov/MCRAdvPartDEnrolData/MEC/itemdetail.asp?filterType=none&filterByDID=­

99&sortByDID=2&sortOrder=descending&itemID=CMS1199141&intNumPerPage=10. Accessed 

June 17, 2007. 

8

 A PACE is a Program of All-Inclusive Care of the Elderly. 42 CFR § 460.6.
 9

 42 CFR § 423.4.

10 J. Hoadley, E. Hargrave, K. Merrell, J. Cubanski, and T. Neuman. “Benefit Design and Formularies of 

Medicare Drug Plans: A Comparison of 2006 and 2007 Offerings.” Kaiser Family Foundation, 2006. 

Available online at http://www.kff.org/medicare/7589.cfm. Accessed June 9, 2007. 11 A plan sponsor may have one contract and offer multiple plans or have several contracts and offer 

multiple plans. 

12 See footnote 7. 
 

 

 

 

Page 3 – Kerry Weems 

call center, an Internet Web site, and the provision of information in writing, upon 

request.13 Our review focuses on one of the required mechanisms, Internet Web sites.14 

Content Requirements for Web Sites 

Each Part D plan sponsor’s Web site must include the information listed below about 

prescription drug coverage under the PDP (see Appendix A for a more detailed 

description):15 

•	 service area; 

•	 benefits; 

•	 ways of obtaining more information on cost-sharing requirements; 

•	 formulary; 

• addresses of network pharmacies; 

• out-of-network coverage; 

•	 grievances, reconsideration, exceptions, coverage determination, and appeal rights 

and procedures; 

•	 quality assurance policies and procedures; 

•	 disenrollment rights and responsibilities; and 

•	 potential for contract termination. 

Additionally, Part D plan sponsors must submit all of their marketing materials 

(including Web sites) to CMS for review of content and approval for distribution.16 

Part D plan sponsors must also demonstrate to CMS that a portion of marketing resources 

is allocated to marketing to the disabled and beneficiaries aged 65 and over.17 

Accessibility Requirements for Web Pages 

Web pages that make up PDP sponsor Web sites must meet certain criteria to ensure that 

individuals with disabilities have comparable access to information about PDPs. Federal 

regulation establishes 16 specific accessibility requirements for Web-based information 

and applications (see Appendix B).18 These requirements focus on enabling assistive 

technology tools designed for persons with disabilities and are particularly critical for 

Web sites designed specifically for Medicare beneficiaries, such as PDP sponsor Web 

sites. In 2000, sensory disabilities, such as blindness, deafness, or a severe vision or 

13 42 CFR § 423.128(d). 

14 A Web site is a set of interconnected Web pages. A Web page is an individual document in Hypertext
 

Markup Language (HTML) contained in the Web site. Available online at www.techterms.com. Accessed 

July 30, 2007. 

15 42 CFR § 423.128(b). 

16 42 CFR § 423.50. 

17 42 CFR § 423.50(f)(viii)(2)(i). 

18 36 CFR § 1194.22. 
 

 

 

 

 

 

 

 

Page 4 – Kerry Weems 

hearing impairment, affected approximately 14 percent of the civilian 

noninstitutionalized population aged 65 years and older.19 20 

Compliance with 4 of the 16 accessibility requirements can be assessed automatically, 

using commercially available electronic tools.21 The four requirements are: 

(1) Text equivalents. A nontext element conveys meaning through pictures (images, 

graphics) or sound (audio clips). Federal regulations require that text equivalents 

accompany every nontext element.22 For example, an image indicating a navigational 

action should also have appropriate text, such as “Move to the next screen.”23 This is 

necessary because speech synthesizers and Braille displays use the text description to 

explain the meaning of the image.24 25 When audio clips convey instructions or 

information, a text equivalent, such as a transcript, must be provided to ensure that the 

information is available to those with auditory impairments.26 

(2) Frames. Frames must be titled with text that facilitates frame identification and 

navigation.27 Frames provide a way of dividing a computer screen into distinct areas. 

They also can be obstacles for users with disabilities if the frames are not easily 

identifiable to assistive technology. For example, one use of frames is to provide 

navigational bars that remain in a fixed position while the content is displayed on another 

19 U.S. Census Bureau, “Census 2000 Summary File 3 (SF-3) - Sample Data.” Table P41: Age by Types 

of Disability for the Civilian Noninstitutionalized Population 5 Years and Over With Disabilities [19]. 

Available online at http://factfinder.census.gov/servlet/DTTable?_bm=y&-geo_id=01000US&­

ds_name=DEC_2000_SF3_U&-_lang=en&-mt_name=DEC_2000_SF3_U_P041&-format=&-

CONTEXT=dt. Accessed July 23, 2006. 20 The Census Bureau determined disability status through responses to questions about the existence of 

long-lasting conditions such as blindness, deafness, severe vision or hearing impairment; physical, mental, 

or emotional conditions lasting more than 6 months; and conditions that substantially limit one or more 

basic physical activities. Available online at
 

http://www.census.gov/acs/www/Downloads/2005/usedata/Subject_Definitions.pdf#page=31 and 

http://www.census.gov/dmd/www/pdf/d-61b.pdf. Accessed July 26, 2007. 21 The four requirements that can be checked automatically are 36 CFR § 1194.22(a), (i), (m), and (n). All 

other Federal requirements require manual checks. 

22 36 CFR § 1194.22(a). 

23 United States Access Board, “Web-Based Intranet and Internet Information and Applications (1194.22),” 

2001. Available online at http://www.access-board.gov/sec508/guide/1194.22.htm. Accessed 

September 15, 2006. 

24 Ibid. 

25 W. Chisholm, G. Vanderheiden, and I. Jacobs, “Web Content Accessibility Guidelines 1.0,” 1999. 

Available online at http://www.w3.org/TR/1999/WAI-WEBCONTENT-19990505. Accessed 

September 14, 2006. 

26 J. Ellison, “Assessing the Accessibility of Fifty United States Government Web Pages: Using Bobby to
 

Check on Uncle Sam,” 2004. Volume 9 (7). Available online at
 

http://www.firstmonday.org/issues/issue9_7/ellison/index.html. Accessed May 8, 2007. 27 36 CFR § 1194.22(i). 
 

 

 

 

Page 5 – Kerry Weems 

area of the screen. Users with disabilities may have difficulty navigating the page if the 

different areas are not clearly defined by including text titles on the frames.28 

(3) Links to plug-ins or applets. When a Web page requires an applet, a plug-in, or some 

other application to enable a user to interpret page content, the page must provide a link 

to the necessary plug-in or applet.29 Some PDP sponsors’ Web site home pages use file 

formats that require plug-ins or applets that are downloaded and installed on the 

enrollee’s computer. For example, a Web page containing links to materials in Adobe 

Acrobat’s® Portable Document Format (PDF) must also provide a link to the plug-in 

needed to read the PDF file.30 Some Web pages may use applets to create such design 

features as scrolling text. The user must be able to operate the applet either by mouse or 

by keyboard. If not, the information is inaccessible to persons with visual disabilities 

who rely upon a screen reader and keyboard to navigate the site. The lack of an applet 

link could also affect persons with motor disabilities who must rely upon assistive 

devices to navigate a keyboard.31 32 

(4) Online forms. Online forms must be designed so that people using assistive 

technology may access information, field elements, and functionality that are required for 

completion and submission of the forms.33 For example, if an input box on a form is 

intended for receiving a user’s last name, the words “last name” (or some similar text) 

should appear near that input box or should be associated with it.34 

Internet Usage 

The use of the Internet by older adults and persons with disabilities as a mechanism to 

obtain health-related information has expanded in recent years. The most recent figures 

available on Internet usage indicate that about 8.5 million adults aged 65 years and older 

in the United States (25 percent of all seniors) report using the Internet to access 

28 United States Access Board, “Web-Based Intranet and Internet Information and Applications (1194.22),” 

2001. Available online at http://www.access-board.gov/sec508/guide/1194.22.htm. Accessed 

September 15, 2006. 

29 36 CFR § 1194.22(m). 

30 J. Ellison, “Assessing the Accessibility of Fifty United States Government Web Pages: Using Bobby to
 

Check on Uncle Sam,” 2004. Volume 9 (7). Available online at
 

http://www.firstmonday.org/issues/issue9_7/ellison/index.html. Accessed May 8, 2007. 31 L. R. Kasday, D. N. Bryen, and P. R. Bohman, “Web Browsing Challenges, Strategies, and Tools for 

People With Motor Disabilities and Users of AAC Technologies,” 2001–2003. Available online at 

http://www.webaim.org/projects/whitepaper.htm. Accessed June 29, 2007. Web Accessibility In Mind, 

“Motor Disabilities: Assistive Technologies.” Available online at 

http://www.webaim.org/articles/motor/assistive.php. Accessed June 29, 2007. 32 Keynote NetMechanic, “Building Web Sites That Comply with Section 508 Accessibility Guidelines.” 

Available online at http://www.netmechanic.com/accessibility/accessibility-requirements.shtml. Accessed 

August 2, 2007. 

33 36 CFR § 1194.22(n). 

34 W. Chisholm, G. Vanderheiden, and I. Jacobs, “Web Content Accessibility Guidelines 1.0,” 1999. 

Available online at http://www.w3.org/TR/1999/WAI-WEBCONTENT-19990505. Accessed 

September 14, 2006. 
 

 

 

 

Page 6 – Kerry Weems 

information.35 Forty-seven percent of those seniors used the Internet as a source of 

information on health services or practices and 32 percent for information on government 

services or agencies.36 

According to one survey, approximately 38 percent of persons with disabilities indicated 

that they used the Internet. Within this group, 87 percent said that they had searched for 

at least one health-related topic.37 Prior to the implementation of Part D, persons living 

with disabilities were reportedly just as likely as other Americans to use the Internet to 

search for drug information, underscoring the importance of comparable access to Webbased information.38 

METHODOLOGY 

We examined the Web sites of all 84 PDP sponsors offering drug plans within the 

50 States and the District of Columbia in 2007.39 Each plan sponsor is required to have a 

Web site containing information about all of its PDPs. To identify Web site addresses for 

PDP sponsors, we used Medicare.gov, which lists each PDP and associated Web site. 

Additionally, we verified that the Web address provided on Medicare.gov was the same 

address that was included in information provided to enrollees by comparing online 

versions of the Summary of Benefits and Evidence of Coverage to the Medicare.gov 

address.40 We calculated the proportion of beneficiaries enrolled in each PDP using 

enrollment figures reported by CMS as of May 2007.41 We conducted the review during 

April and May 2007. 

We reviewed each Web site to determine whether the required content was available. We 

began by reviewing the plan sponsor’s home page, which is the starting page or front 

page of a Web site.42 When required content was not available on the home page, we 

reviewed other documents available through links from the home page. We considered 

35 U.S. Census Bureau, “Current Population Survey.” Table 9B. Purpose of Internet Use for People 18 

Years and Over Using the Internet Anywhere, by Selected Characteristics: October 2003. Available online 

at http://www.census.gov/population/socdemo/computer/2003/tab098.xls. Accessed July 23, 2007. 36 Ibid. 

37 Pew Internet & American Life Project, “Internet Health Resources,” July 16, 2003. Available online at 

http://www.pewinternet.org/pdfs/PIP_Health_Report_July_2003.pdf. Accessed August 24, 2007. 38 Pew Internet & American Life Project, “Prescription Drugs Online,” October 10, 2004. Available online 

at http://www.pewinternet.org/pdfs/PIP_Prescription_Drugs_Online.pdf. Accessed August 24, 2007. 

39 We excluded PDP sponsors with service areas only in Puerto Rico and U.S. territories and we did not 

include Medicare Advantage Prescription Drug Plans. 

40 CMS requires PDPs to provide the “Evidence of Coverage” and “Summary of Benefits” via the PDP 

Web page and in hard copy form, according to the “Medicare Marketing Guidelines for: Medicare 

Advantage Plans, Medicare Advantage Prescription Drug Plans, Prescription Drug Plans, and 1876 Cost 

Plans.” Second revision, July 25, 2006. Available online at 

http://www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/FinalMarketingGuidelines.pdf. Accessed 

August 16, 2006. 

41 See footnote 7 on p. 2. 42 Available online at www.techterms.com. Accessed July 30, 2007. 
 

 

 

 

 

 

Page 7 – Kerry Weems 

the content available if it was present on the home page or elsewhere on the Web site. 

We did not assess the quality of the information or the policies and procedures described 

on the Web site. 

We also reviewed each sponsor’s home page to assess the Web site for compliance with 

Federal requirements regarding accessibility. We used two electronic tools that enable 

page-level testing of Web-based information and applications: WebXactTM and Cynthia 

SaysTM.43 44 Both tools determine compliance with the same four Federal accessibility 

requirements using automated procedures. Our assessment was limited to those four 

requirements (i.e., text equivalents, frames, links to plug-ins or applets, and online 

forms).45 The primary assessment tool was WebXactTM. We used Cynthia SaysTM when 

the structure or design of a page prohibited an assessment by WebXactTM. Although 

neither of the programs measures the full range of accessibility and usability issues, both 

identify basic design errors that could impede access to Web page content. If either of 

the programs identifies errors, it is reasonable to conclude that accessibility problems 

exist.46 47 

In addition to examining the four accessibility requirements on the 84 PDP sponsors’ 

home pages, we examined specific Web pages that contained information related to 

grievances, coverage determinations, and appeal rights for each PDP sponsor. Many 

Web sites included this information only through links to files in PDF. For these sites, 

we used WebXactTM and Cynthia SaysTM to determine whether the required link to the 

plug-in program was available on the page containing information on grievances, 

coverage determinations, and appeal rights. 

To determine whether any change in accessibility occurred over time, we compared 2006 

and 2007 PDP sponsor home pages. We found that 68 PDP plan sponsors within the 

50 States and the District of Columbia had contracts in both 2006 and 2007. We 

conducted reviews of the 2006 home pages using WebXactTM and Cynthia SaysTM 

between September and November 2006. 

43 WebXactTM is an updated version of the free online tool BobbyTM, an accessibility evaluation tool used in
 

many earlier studies on Web page accessibility. Cynthia SaysTM functions in a similar fashion, although it 

may not identify as many Web page accessibility errors as WebXactTM (Ellison, 2004). The free online
 

service WebXactTM is no longer available, as of July 15, 2007. 

44 W. Chisholm, G. Vanderheiden, and I. Jacobs, “Web Content Accessibility Guidelines 1.0,” 1999. 

Available online at http://www.w3.org/TR/1999/WAI-WEBCONTENT-19990505. Accessed 

September 14, 2006. 

45 36 CFR § 1194.22(a), (i), (m), and (n). 46 P. T. Jaeger, “The Importance of Accurately Measuring the Accessibility of the Federal Electronic 

Government: Developing the Research Agenda,” Information Technology and Disabilities, 9(1). 2003. 

Available online at http://www.rit.edu/~easi/itd/itdv09n1/jaeger.htm. Accessed May 9, 2007. 47 J. Ellison, “Assessing the Accessibility of Fifty United States Government Web Pages: Using Bobby to
 

Check on Uncle Sam,” 2004. Volume 9 (7). Available online at
 

http://www.firstmonday.org/issues/issue9_7/ellison/index.html. Accessed May 8, 2007. 
Page 8 – Kerry Weems 

This study was conducted in accordance with the “Quality Standards for Inspections” 

issued by the President’s Council on Integrity and Efficiency and the Executive Council 

on Integrity and Efficiency. 
 

Page 9 – Kerry Weems 

RESULTS 

Thirty-Three Percent of Web Sites Reviewed Did Not Contain All Required Content 

Twenty-eight of the 84 PDP sponsors’ Web sites did not contain all required content (see 

Table 1). These 28 plan sponsors serve 39 percent of all PDP enrollees. The most 

commonly omitted information pertained to enrollee disenrollment rights and 

responsibilities, the potential for PDP contract termination, and information related to the 

formulary. 

Table 1: Medicare Part D Prescription Drug Plan Sponsor Web Sites That Did Not 

Contain All Federally Required Content 

Contenta 

Number of 

Web Sites 

Without 

Content 

(n = 84)b 

Percentage of 

Web Sites 

Without 

Content 

Percentage 

of Enrollees 

in PDPsc 

Disenrollment rights and responsibilities 13 15% 23% 

Potential for contract termination 13 15% 10% 

Formulary 13 15% 8% 

Quality assurance policies and 

procedures 

7 8% 7% 

Benefits 6 7% 7% 

Addresses of network pharmacies 5 6% 7% 

Out-of-network coverage 4 5% <1% 

Service area 3 4% <1% 

Grievance, reconsideration, exceptions, 

coverage determination, and appeal rights 

and procedures 

3 4% <1% 

How to obtain more information on 

cost-sharing requirements 

2 2% <1% 

Web sites that did not contain all 

federally required content 28 33% 39% 

a 42 CFR § 423.128(b). 

b OIG analysis of Web sites, April 1–May 31 2007.
 c

 CMS, “Medicare Advantage, Cost, PACE, Demo, and Prescription Drug Plan Organizations–Monthly Report by
 

Contract–May 2007.” 

Because PDP sponsors with larger plans serve more enrollees, the absence of required 

information from their Web sites potentially affects more enrollees. For example, the 

same number of Web sites (13) lacked information about both disenrollment and 
 

 

 

Page 10 – Kerry Weems 

formulary. However, because of differences in the number of enrollees among those plan 

sponsors, the proportion of enrollees in plans with Web sites that fell short of required 

disenrollment information and formulary information differed between disenrollment 

(23 percent) and formulary (8 percent). 

One of the 84 Web sites contained only information about the PDP service area, lacking 

the other nine required content elements. When we contacted that PDP to verify the lack 

of content, a customer service representative confirmed that the information is not 

available on the Web site and offered to send a brochure with the information. 

Eighty-Five Percent of Sponsor Web Sites Did Not Meet at Least One of the Four 

Federal Requirements Reviewed for Accessibility 

Our review, using the electronic Web page assessment tools WebXactTM and Cynthia 

SaysTM, revealed that 71 of the 84 PDP sponsors’ Web site home pages had errors related 

to at least one of the accessibility requirements we reviewed (see Table 2). For enrollees 

who have specific disabilities, PDP information on their sponsors’ Web sites could be 

inaccessible. 

Table 2: Sponsor Web Site Home Pages With Errors Identified in at Least One of the 

Four Federal Requirements Reviewed for Accessibility 

Web-Based Information and 

Applicationa 

Number of Home 

Pages With 

Accessibility 

Errors 

(n = 84) b 

Percentage of 

Home Pages 

With 

Accessibility 

Errors 

Percentage 

of Enrollees in 

PDPsc 

Text equivalents 

Online forms 

Links to plug-ins or applets 

Frames 

53 

48 

16 

2 

63% 

57% 

19% 

2% 

78% 

23% 

9% 

2% 

Home pages with errors 

associated with at least one 

Federal requirement for 

accessibility 

71 85% 98% 

a

 36 CFR § 1194.22(a), (i), (m), and (n). 

b OIG analysis of Web sites, April 1–May 31 2007.
 c CMS, “Medicare Advantage, Cost, PACE, Demo, and Prescription Drug Plan Organizations–Monthly Report by
 

Contract–May 2007.” 

Additionally, we compared 2006 and 2007 PDP sponsors’ home pages for the 68 plan 

sponsors with contracts for both years. We found little change in Web page accessibility. 
Page 11 – Kerry Weems 

Eighty-seven percent of the home pages for 2006 had errors identified in at least one of 

the four Federal requirements we reviewed, compared to 85 percent of the 2007 home 

pages. 

We also analyzed Web pages with content related to grievances, coverage 

determinations, and appeal rights. Forty-three percent of the Web pages devoted to 

coverage determination used plug-ins or applets to present information but did not 

provide links to the plug-ins or applets. This is significantly higher than the 19 percent of 

Web sites with problems identified on their home pages, demonstrating that accessibility 

problems are not limited to PDP sponsors’ Web site home pages. 

CONCLUSION 

Pursuant to Federal regulations, CMS must review and approve marketing materials for 

Part D prescription drug plans, including materials provided through Part D sponsors’ 

Web sites. Our review found that 33 percent of the 84 PDP sponsors did not provide all 

federally required content on their Web sites. We also found that 85 percent of the 

84 PDP sponsors’ home pages we reviewed did not meet at least one of the four Federal 

requirements for Web site accessibility, potentially affecting access to content by 

Medicare beneficiaries. 

The use of computers and the Internet is increasing among adults aged 65 and older and 

utilizing the Internet as a mechanism to provide information on prescription drug plans is 

vital. It is important that CMS oversee these Web sites to ensure that all Medicare 

beneficiaries, including beneficiaries with disabilities, have comparable access to 

federally required content to make informed decisions about their prescription drug 

coverage. 

This report is being issued directly in final form because it contains no recommendations. 

If you have comments or questions about this report, please provide them within 60 days. 

If you have any questions about this report, please do not hesitate to call me or one of 

your staff may contact Claire Barnard at (202) 205-9523 or through e-mail 

(Claire.Barnard@oig.hhs.gov). To facilitate identification, please refer to report number 

OEI-06-06-00340 in all correspondence. 
Page 12 – Kerry Weems 

Appendix A 

PDP Sponsor Web Site Content Requirements 

Content Description 

Service area Provides details of the plan’s service area. 

Benefits Provides a description of the benefits offered, including 

conditions and limitations, premiums, cost sharing 

(copayments, deductibles, coinsurance, and subsidy-eligible 

individuals), and any other conditions. 

Ways of obtaining more 

information on cost-sharing 

requirements 

Provides a description of how an individual may obtain more 

information on cost-sharing requirements, including tiered or 

other copayment levels applicable to each drug or class of 

drug. 

Formulary Provides information about the plan’s formulary, including a 

list of drugs, the manner in which the formulary functions 

(including any tiered formulary structure and utilization 

management procedures used), the process for obtaining an 

exception to a plan’s formulary or tiered cost-sharing 

structure, and a description of how a Part D-eligible individual 

may obtain additional information on the formulary. 

Network pharmacies Provides addresses of network pharmacies from which 

enrollees may expect to obtain covered drugs. 

Out-of-Network coverage Provides information regarding access to covered Part D 

drugs at out-of-network pharmacies. 

Grievances, reconsideration, 

exceptions, coverage 

determination, and appeal rights 

and procedures 

Provides information on the procedures for timely hearing and 

resolution for grievances, coverage determinations, and 

appeals. 

Quality assurance policies and 

procedures 

Provides a description of the quality assurance policies and 

procedures and the medication therapy management 

program. 

Disenrollment rights and 

responsibilities 

Provides information on enrollees’ disenrollment rights and 

responsibilities. 

Potential for contract termination Provides information on the fact that a Part D sponsor may 

terminate or decline to renew its contract or reduce the service 

area included in its contract and on the effect of any of these 

actions on enrollees. 

Source: 42 CFR § 423.128(b). 
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Page 13 – Kerry Weems 

Appendix B 

Federal Accessibility Requirements for Web Based Information 

36 CFR § 1194.22 

Paragraph Web-Based Information and Application 

(a) A text equivalent for every nontext element shall be provided. 

(b) Equivalent alternatives for any multimedia presentation shall be synchronized 

with the presentation. 

(c) Web pages shall be designed so that all information conveyed with color is 

available without color. 

(d) Documents shall be organized so that they are readable without requiring an 

associated style sheet. 

(e) Redundant text links shall be provided for each active region of a server-side 

image map. 

(f) Client-side image maps shall be provided instead of server-side image maps 

except where the regions cannot be defined with an available geometric shape. 

(g) Row and column headers shall be identified for data tables. 

(h) Markup shall be used to associate data cells and header cells for data tables 

that have two or more logical levels of row or column headers. 

(i) Frames shall be titled with text that facilitates frame identification and 

navigation. 

(j) Pages shall be designed to avoid causing the screen to flicker with a frequency 

greater than 2 Hz and lower than 55 Hz. 

(k) 

A text-only page, with equivalent information or functionality, shall be provided 

to make a Web site comply with the provisions of this part when compliance 

cannot be accomplished in any other way. The content of the text-only page 

shall be updated whenever the primary page changes. 

(l) 

When pages utilize scripting languages to display content, or to create interface 

elements, the information provided by the script shall be identified with 

functional text that can be read by assistive technology. 

(m) 

When a Web page requires that an applet, a plug-in, or other application be 

present on the client system to interpret page content, the page must provide a 

link to a plug-in or an applet that complies with § 1194.21 (a) through (l). 

(n) 

When electronic forms are designed to be completed online, the form shall 

allow people using assistive technology to access the information, field 

elements, and functionality required for completion and submission of the form, 

including all directions and cues. 

(o) A method shall be provided that permits users to skip repetitive navigation links. 

(p) When a timed response is required, the user shall be alerted and given 

sufficient time to indicate that more time is required. 

Source: 36 CFR § 1194.22.