United States Government Accountability Office

GAO Report to Congressional Requesters

MEDICARE PART D

Prescription Drug Plan 

Sponsor Call Center 

Responses Were 

Prompt, but Not 

Consistently Accurate 

and Complete 

June 2006 

 

GAO-06-710 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

June 2006

MEDICARE PART D

Prescription Drug Plan Sponsor Call 

Center Responses Were Prompt, but Not 

Consistently Accurate and Complete 

Highlights of GAO-06-710, a report to 

congressional requesters 

The Medicare Prescription Drug, 

Improvement, and Modernization 

Act of 2003 (MMA) established a 

voluntary outpatient prescription 

drug benefit, known as Medicare 

Part D. Private sponsors have

contracted with the Centers for

Medicare & Medicaid Services 

(CMS) to provide this benefit and 

are offering over 1,400 stand-alone 

prescription drug plans (PDP). 

Depending on where they live, 

beneficiaries typically have a 

choice of 40 to 50 PDPs, which vary

in cost and coverage. MMA 

required each PDP sponsor to staff 

a toll-free call center, which serves

as a key source of the information 

that beneficiaries need to make

informed choices among PDPs.

GAO examined (1) whether PDP 

sponsors provide prompt, 

courteous, and helpful service to

Medicare beneficiaries and others 

and (2) the extent to which PDP 

sponsor call centers provide 

accurate and complete information 

to Medicare beneficiaries and other

callers. 

To address these objectives, we

made 900 calls to 10 of the largest

PDP sponsor call centers during 

March 2006, posing one of five 

questions about their Part D plans 

during each call. We tracked the

amount of time it took to reach a 

customer service representative

(CSR), the number of calls that did 

not reach a CSR, and the 

appropriateness and clarity of

CSRs’ language. We developed 

criteria for determining accurate

and complete responses based on 

CMS information. 

Call center service was generally prompt and courteous, and many CSRs 

offered helpful suggestions and information. GAO reached a representative

in less than 1 minute for 46 percent of the calls CSRs fielded and in less than 

5 minutes for 96 percent of the calls fielded. While GAO did not reach CSRs 

for 4 percent of the calls it placed, mainly because of disconnections, GAO 

found that 98 percent of CSRs with whom GAO spoke were easy to 

understand, polite, and professional. In addition, many CSRs provided 

helpful suggestions related to GAO’s questions, such as details about a mailorder option to obtain drugs or lower-cost drugs. 

However, CSRs at 10 of the largest PDP sponsor call centers did not 

consistently provide accurate and complete responses to GAO’s five 

questions, which GAO developed using information from CMS and other 

sources. GAO obtained accurate and complete responses to about one-third

of the 864 calls for which GAO reached a CSR. The overall accuracy and 

completeness rate for each call center ranged from 20 to 60 percent. CSRs 

were unable to answer 15 percent of the questions posed, primarily those 

related to plan costs. Furthermore, CSRs within the same call center 

sometimes provided inconsistent answers. For example, in response to 

questions about PDP cost comparisons for specified sets of drugs, CSRs at 3 

call centers told GAO that it was against the sponsors’ policies to identify 

any of their plans as lowest cost. However, other CSRs at each of these call 

centers did not cite this policy and did identify a plan as lowest cost. 

Percentage of 864 Calls with Accurate and Complete, Incomplete, or Inaccurate Responses, 

and Those Where No Answer Was Provided, March 2006 

Accurate and complete

Incomplete

Inaccurate

No answer provided

15%

29%

34%

22%

Source: GAO.

In commenting on a draft of this report, CMS criticized the analysis as based 

on inaccurate, incomplete, and subjective methods that limit the report’s 

relevance and validity. GAO maintains that its methods are sound and its 

findings are accurate. CMS officials told GAO at a May 2006 meeting that 

CSRs should have been able to accurately answer the questions GAO posed. 

www.gao.gov/cgi-bin/getrpt?GAO-06-710.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Leslie G. 

Aronovitz at (312) 220-7600. 
Contents 

Letter 1

Results in Brief 6 

Background 7

CSRs Generally Provided Prompt, Courteous, and Helpful Service 9 

PDP Sponsor Call Centers Did Not Consistently Provide Callers 

with Accurate and Complete Information 12 

Concluding Observations 20 

Agency Comments and Our Evaluation 20 

Appendix I Comments from the Centers for Medicare & 

Medicaid Services 26 

Appendix II GAO Contact and Staff Acknowledgments 30 

Table 

Table 1: Questions, Scenarios, and Criteria Used to Assess 

Response Accuracy and Completeness 5 

Figures 

Figure 1: Percentage of Calls by Wait Time to Reach a CSR, and 

Percentage of Calls Where We Did Not Reach a CSR, 

March 2006 11 

Figure 2: Percentage of Calls with Accurate and Complete, 

Incomplete, or Inaccurate Responses, and Those Where 

No Answer Was Provided, March 2006 13 

Figure 3: Lowest, Highest, and Average Sponsor Call Center 

Accuracy and Completeness Rate, by Question, March 

2006 14

Figure 4: Percentage of Calls with Accurate and Complete, 

Incomplete, or Inaccurate Responses, and Those Where 

No Answer Was Provided, by Question, March 2006 16 

Page i GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
Abbreviations 

CMS Centers for Medicare & Medicaid Services 

CSR customer service representative 

MMA Medicare Prescription Drug, Improvement, and 

 Modernization Act of 2003 

PDP prescription drug plan 

This is a work of the U.S. government and is not subject to copyright protection in the 

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permission from GAO. However, because this work may contain copyrighted images or 

other material, permission from the copyright holder may be necessary if you wish to 

reproduce this material separately. 

Page ii GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
United States Government Accountability Office

Washington, DC 20548 

June 30, 2006 

Congressional Requesters

The Medicare Prescription Drug, Improvement, and Modernization Act of 

2003 (MMA) established a voluntary outpatient prescription drug benefit,

known as Medicare Part D, beginning January 1, 2006.1

 Seventy-nine 

sponsors, largely commercial insurers, have contracted with the Centers 

for Medicare & Medicaid Services (CMS)—the agency that administers 

Medicare—to provide this benefit in 2006. These sponsors offer over 1,400 

stand-alone Medicare prescription drug plans (PDPs) in one or more of 34 

CMS-designated PDP regions.2

 Depending on where they live, Medicare 

beneficiaries typically have a choice of 40 to 50 PDPs, which vary in cost 

and coverage. Generally, beneficiaries had until May 15, 2006, to enroll in

Part D without the risk of a penalty in the form of higher premiums; as of 

June 11, 2006, about 16.4 million beneficiaries had enrolled in stand-alone 

PDPs. 

The Medicare Prescription Drug, Improvement, and Modernization Act of 

2003 (MMA) established a voluntary outpatient prescription drug benefit,

known as Medicare Part D, beginning January 1, 2006.1

 Seventy-nine 

sponsors, largely commercial insurers, have contracted with the Centers 

for Medicare & Medicaid Services (CMS)—the agency that administers 

Medicare—to provide this benefit in 2006. These sponsors offer over 1,400 

stand-alone Medicare prescription drug plans (PDPs) in one or more of 34 

CMS-designated PDP regions.2

 Depending on where they live, Medicare 

beneficiaries typically have a choice of 40 to 50 PDPs, which vary in cost 

and coverage. Generally, beneficiaries had until May 15, 2006, to enroll in

Part D without the risk of a penalty in the form of higher premiums; as of 

June 11, 2006, about 16.4 million beneficiaries had enrolled in stand-alone 

PDPs. 

MMA requires each PDP sponsor to staff a toll-free call center. These call 

centers serve as key sources of the information that beneficiaries need to

make informed choices among competing drug plans. Beneficiaries and 

others assisting them may contact call centers to obtain general 

information on Part D, ask detailed questions or verify information from 

other sources about a sponsor’s PDPs, or enroll in a PDP.3

 Because 

beneficiaries have an opportunity to switch to another PDP during an 

MMA requires each PDP sponsor to staff a toll-free call center. These call 

centers serve as key sources of the information that beneficiaries need to

make informed choices among competing drug plans. Beneficiaries and 

others assisting them may contact call centers to obtain general 

information on Part D, ask detailed questions or verify information from 

other sources about a sponsor’s PDPs, or enroll in a PDP.3

 Because 

beneficiaries have an opportunity to switch to another PDP during an 

 1

Pub. L. No. 108-173, § 101, 117 Stat. 2066, 2071-2152 (to be codified at 42 U.S.C. §§ 1395w101—1395w-152). 

2

Although beneficiaries may obtain drug coverage through either stand-alone PDPs or 

Medicare Advantage (Medicare’s private health plan option) drug plans, this report 

addresses only stand-alone PDP sponsor call centers. About 90 percent of Medicare 

beneficiaries are enrolled in traditional Medicare, rather than Medicare Advantage. 

Therefore, most beneficiaries will be making choices among stand-alone PDPs.

3

Other sources of information about Part D and specific PDPs include sponsors’ Web sites,

and CMS’s Medicare.gov Web site and 1-800-MEDICARE toll-free help line. 

Page 1 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
annual open-enrollment period, sponsor call centers will continue to play a 

significant role in informing current and prospective enrollees.4

You were interested in the quality of the service and information provided 

to beneficiaries by PDP sponsor call centers, as inaccurate or misleading 

benefit information could lead beneficiaries to choose a PDP that does not 

meet their needs. In this report, we examined (1) whether PDP sponsors 

provide prompt, courteous, and helpful service to Medicare beneficiaries 

and others accessing their toll-free call centers, and (2) the extent to 

which PDP sponsors provide accurate and complete information to 

Medicare beneficiaries and other callers. 

To address these objectives, we made 900 calls to 10 of the largest PDP 

sponsor call centers, all of which operate in 30 or more PDP regions and 

offer two or three PDPs per region.5

 As of April 27, 2006, each of these 

sponsors served at least 100,000 beneficiaries. Each of our 10 sponsors has 

one toll-free call center, which we contacted from March 2 through 

March 31, 2006. We posed one of five questions about their Part D plans 

during each call, asking each question a total of 180 times—18 times to 

each of the 10 PDP sponsors.6

 We developed scenarios with zip codes and 

fictional relatives for each of the questions. To make them sound realistic 

and provide needed information, we specified additional details, such as 

drug dosage and frequency information, lack of current drug coverage, 

low-income subsidy eligibility, and preference for retail purchasing, if 

asked.7

In developing our five questions, we examined those addressed by the 

Frequently Asked Questions section of CMS’s Medicare.gov Web site. We

 4

The 2006 open enrollment period is November 15, 2006, through December 31, 2006. 

Beneficiaries enrolling during this period will have coverage effective January 1, 2007. 

Certain beneficiaries (such as certain low-income beneficiaries) may switch PDPs at any 

time. 

5

We placed calls at different times of the day and days of the week to match the typical 

pattern of calls reported by the 1-800-MEDICARE help line for January 2006. (CMS requires 

that each PDP sponsor operate its toll-free call center 7 days a week from at least 8:00 am

to 8:00 pm in the time zones in which it offers PDPs.) The population contacting 

1-800-MEDICARE is likely to be very similar to the population contacting PDP sponsor call 

centers. 

6

During our actual calls, CSRs were not aware that their responses would be included in a 

research study. 

7

We used drug dosages and frequency information based on actual prescriptions. 

Page 2 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
also reviewed materials from policy analysts that identified information 

critical to making a choice among competing plans.8

 In addition, we spoke 

with representatives of beneficiary advocacy groups about the types of 

information beneficiaries need to consider when selecting a PDP plan. 

Finally, we asked CMS officials what types of information they required or

expected call center customer service representatives (CSR) to be able to 

provide the public and developed our questions from this information. 

Although CMS does not have requirements regarding the specific types of 

information CSRs must be able to provide, agency officials told us that 

CSRs should be able to accurately answer questions about the relative 

costs of a sponsor’s PDPs, the availability of a plan for beneficiaries 

eligible for Medicare’s low-income subsidy, actions that beneficiaries 

could take if their drugs are not covered by the plan, and types of 

restrictions plans use to manage their formularies. 

To evaluate the extent to which sponsor call centers provided prompt, 

courteous, and helpful service during our calls, we analyzed information 

on the amount of time it took to reach a CSR and the number of calls for 

which we could not reach a CSR. In addition, our callers noted if they had 

concerns about the appropriateness and clarity of CSRs’ language. In such

cases, we evaluated whether the CSR was difficult to understand, impolite, 

or unprofessional. We also noted any helpful suggestions or information 

provided to the caller. 

We developed criteria for accurate and complete responses for each 

question from information provided on CMS’s Web-based PDP finder tool

on Medicare.gov9

 and information that CMS has approved for use by its 

1-800-MEDICARE CSRs (see table 1). Excluding calls for which we did not 

reach a CSR, we report results on the accuracy and completeness of 

 8

See J. Antos, “Cutting through Confusion in Part D,” American Enterprise Institute for 

Public Policy Research: Health Policy Outlook, no. 2 (2006): 1-7, and J. Hoadley, statement 

before the Government Reform Committee Briefing on the Medicare Drug Benefit, 

January 20, 2006. 

9

For the three questions about PDP costs, the source of our answer was Medicare.gov. We

periodically checked that Web site and updated our answers, as needed. We also confirmed

the accuracy of these data by checking PDP sponsor Web sites, where possible. 

Page 3 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
information obtained during the remaining calls.10 We considered an 

answer accurate and complete if the CSR’s response met all of our criteria 

and we considered an answer incomplete if the CSR’s response met one,

but not both of our criteria. We considered an answer inaccurate if the 

CSR’s response did not meet any of our criteria. If the CSR stated that they

did not know or could not provide an answer, we classified the call as “no 

answer provided.” 

 10CMS does not have performance standards governing the accuracy rate of PDP call 

centers. However, the agency does have such a standard for 1-800-MEDICARE CSRs, 

striving for a 90 percent accuracy rate. In 2004 and 2006, we reported on the accuracy of 

information provided by 1-800-MEDICARE CSRs. See GAO, Medicare: Accuracy of 

Responses from the 1-800-MEDICARE Help Line Should Be Improved, GAO-05-130 

(Washington, D.C.: Dec. 8, 2004) and GAO, Medicare: Communications to Beneficiaries

on the Prescription Drug Benefit Could Be Improved, GAO-06-654 (Washington, D.C.: 

May 3, 2006). 

Page 4 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
Table 1: Questions, Scenarios, and Criteria Used to Assess Response Accuracy and Completeness 

Question Scenario Criteria for an accurate and complete response 

1. PDP comparison for a 

low-utilization 

beneficiarya

My mother takes the following drugs: Norvasc, 

Fosamax, and warfarin sodium. Which of the 

sponsor’s plans would cost her the least 

amount annually and what is its annual cost? 

The name and annual cost (within 5 percent) of the 

sponsor’s PDP that would cost the beneficiary the least 

annually for the three drugs she uses. 

2. PDP comparison for a 

high-utilization 

beneficiarya

My mother-in-law takes the following drugs: 

Aciphex, Benicar, Evista, Levoxyl, Pravachol,

Synthroid, Zetia, and Zoloft.b Which of the 

sponsor’s plans would cost her the least 

amount annually and what is its annual cost? 

The name and annual cost (within 5 percent) of the 

sponsor’s PDP that would cost the beneficiary the least 

annually for the eight drugs she uses. 

3. Low-income subsidy My mother automatically qualifies for extra help 

because Medicaidc

 pays part of her Medicare 

premiums. Does the sponsor offer a plan that

she can join without having to pay a premium? 

The name of the sponsor’s PDP, if any, for which the 

beneficiary would not pay a premium. 

4. Nonformulary drugs If some of my grandfather’s drugs are not 

covered, will he have to pay full price for them, 

or are there other things he can do? 

A beneficiary may (1) switch to a covered drug, and 

(2) ask for an exception to the formulary. 

5. Utilization 

management tools 

If some of my grandfather’s drugs are covered, 

but subject to restrictions, what does that 

mean? 

Descriptions of at least two of the following: for some 

covered drugs (1) beneficiaries need approval from their 

PDP before they can fill their prescription; (2) the PDP 

limits the amount of the drug that it covers over a certain 

period of time; (3) the PDP requires that the beneficiary 

first try a less expensive drug for their condition before it 

will cover the beneficiary’s prescribed drug; or (4) when 

there is a generic substitute available, the PDP will 

automatically provide the generic, unless the beneficiary’s 

doctor specifically orders the brand-name drug. 

Source: GAO.

Note: We considered an answer accurate and complete if the CSR’s response met all of our criteria. 

We considered an answer incomplete if the CSR’s response met one, but not both, of our criteria. 

Specifically, for questions 1 and 2, a response was incomplete if the CSR accurately named the 

lowest annual cost plan, but either inaccurately calculated or could not provide the annual cost. An 

incomplete answer was not possible for question 3, as it had only one criterion for accuracy and 

completeness. A question 4 response was incomplete if the CSR either stated that the beneficiary 

could switch to a covered drug or that they could ask for an exception, but did not state both these 

possibilities. Finally, a question 5 response was incomplete if the CSR accurately described only one 

utilization management tool. We considered an answer inaccurate if the CSR’s response did not meet 

any of our criteria. If the CSR stated that they did not know or could not provide an answer, we 

classified the call as “no answer provided.” 

a

In 2003, 46 percent of all seniors reported taking five or more prescription drugs. Based on this 

survey finding, we specified three drugs for the low-utilization beneficiary and eight drugs for the highutilization beneficiary. See Health Affairs—Web Exclusive: Prescription Drug Coverage And Seniors: 

Findings From A 2003 National Survey, April 19, 2005. 

b

This scenario is based on a list of medications provided to us by a Medicare beneficiary. We 

recognize that Levoxyl and Synthroid are the same chemically, but retained both drugs in this 

scenario to make the calls as realistic as possible. Specifying that a beneficiary is taking both of these 

drugs did not preclude the ability of CSRs to determine the least costly plan and its annual cost. 

c

Medicaid provides health care coverage to eligible low-income people and is jointly financed by the 

federal government and the states. 

Page 5 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
The results from our 900 calls are limited only to those calls and are not 

generalizable to the population of calls routinely made to sponsor call 

centers by beneficiaries and other callers. Although the five questions we 

posed are among the most critical questions regarding PDP comparison, 

they do not encompass all of the questions callers might ask. We did not 

contact PDP sponsors other than posing questions to the call centers. In 

addition, we did not examine other issues related to the performance of 

call centers, such as CSR qualifications and training, nor did we evaluate

CMS oversight of sponsor call centers. We conducted our work from 

February 2006 through June 2006 in accordance with generally accepted 

government auditing standards. 

Call center service was generally prompt and courteous, and many CSRs 

offered helpful suggestions and information. We reached a representative

in less than 1 minute for 46 percent of the calls CSRs fielded, and in less 

than 5 minutes for 96 percent of the calls fielded. While we did not reach 

CSRs for 36 calls—4 percent of the 900 calls we placed—mainly due to 

disconnections, we found that 98 percent of the CSRs with whom we 

spoke were easy to understand, polite, and professional. Many CSRs also 

provided helpful suggestions related to our questions. For example, for 

our question on the PDP comparison for a high-utilization beneficiary, 

CSRs provided the caller with information about lower-cost drugs in 

41 percent of the calls. 

Results in Brief 

CSRs at 10 of the largest PDP sponsor call centers did not consistently 

provide accurate and complete responses to our five questions. Excluding 

the calls for which GAO did not reach a CSR, GAO obtained accurate and 

complete responses to about one-third of our 864 calls. The overall 

accuracy and completeness rates for the 10 PDP sponsor call centers 

varied widely, ranging from 20 to 60 percent. Only 1 sponsor call center 

had an overall accuracy and completeness rate of greater than 50 percent 

and 2 sponsor call centers had rates of 25 percent or less. CSRs were 

unable to provide an answer for 15 percent of our questions, primarily 

those related to plan costs. Furthermore, CSRs within the same call center 

sometimes provided inconsistent answers. For example, in response to 

questions regarding PDP comparisons, CSRs at 3 call centers told us that it

was against the sponsor’s policies to identify any of their plans as having 

the lowest annual cost. However, other CSRs at each of these call centers

did not cite this policy and did identify a plan as having the lowest annual 

cost. 

Page 6 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
In written comments on a draft of this report, CMS stated that our analysis 

was based on inaccurate, incomplete, and subjective methods that limited 

our report’s relevance and validity. We maintain that our methods are 

sound and that our findings are accurate. In conducting this review, we 

identified topics that CMS, policy analysts, and beneficiary advocacy 

groups indicated were key to making an informed plan choice, posed 

questions as we expected beneficiaries’ family members to do, and relied

on information from CMS to develop criteria to assess the accuracy and 

completeness of the responses we received. Further, CMS officials told us

at a May 2006 meeting that CSRs should have been able to accurately 

answer the questions we posed. Our findings indicate that beneficiaries 

may have difficulty getting appropriate information from PDP sponsors’ 

call centers. CMS also stated in its written comments that we were right to 

be concerned about whether beneficiaries are getting effective services 

from plan call centers. 

Medicare Part D coverage is provided through private sponsors that offer a 

choice of PDPs with different costs and coverage. The largest sponsors 

offer PDPs to beneficiaries throughout the United States and generally

have experience in providing Medicare coverage and with call center 

operations. 

Under Part D, each PDP may offer the standard prescription drug benefit 

or coverage that is different, but at least actuarially equivalent, to the 

standard benefit.11 According to the Medicare Payment Advisory 

Commission, for 2006, 9 percent of PDPs offer the standard benefit, 

48 percent offer a basic plan that has the same actuarial value as the 

standard benefit but with a different design, and 43 percent offer enhanced

coverage that exceeds the standard benefit.12 Therefore, the specific 

Background 

Key Features of Medicare 

Part D 

 11As defined in MMA, for 2006, the standard benefit includes a $250 deductible, and 

25 percent coinsurance for costs after the deductible has been met, but before the initial 

limit of $2,250 in total drug spending is reached. Once this initial limit is reached, 

beneficiaries must pay 100 percent of their drug costs until total drug spending reaches the

catastrophic limit of $5,100 ($3,600 in out-of-pocket spending). The amount between $2,250

and $5,100 is referred to as the “coverage gap.” Once beneficiaries reach the catastrophic 

limit, they pay only 5 percent of their drug costs for the rest of the calendar year, with 

Part D paying 95 percent. 

12Medicare Payment Advisory Commission, Report to the Congress: Increasing the Value of

Medicare (Washington, D.C. June 2006), 145.

Page 7 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
premium, deductible, and copayment or coinsurance amounts, as well as 

the coverage gap—the period during which beneficiaries must pay 

100 percent of their drug costs—of each PDP may vary. 

In addition, MMA and CMS regulations require plan formularies—the list 

of drugs a PDP covers—to meet certain standards, but within these 

standards, the drugs that are covered and the utilization management tools 

that are used to control costs may vary.13 If beneficiaries’ drugs are not on 

their PDP’s formulary, rather than paying full (retail) price for them, 

beneficiaries may switch to a similar drug that is on the formulary. 

Beneficiaries may also request that the plan make an exception to the 

formulary and cover their drugs.14 If the PDP denies that request, CMS 

regulations require that beneficiaries generally be able to appeal the 

decision to the sponsor.15

Although certain drugs may be on a PDP’s formulary, they may be subject 

to one or more of several utilization management tools—the most 

common of which are prior authorization, quantity limits, step therapy, 

and generic substitution. For drugs subject to prior authorization, 

beneficiaries need approval from their PDP before they can fill their 

prescription and for drugs subject to quantity limits, the plan limits the 

amount of the drug it covers over a certain period of time. For drugs 

subject to step therapy, the PDP requires that the beneficiary first try a 

less expensive drug for their condition before it will cover the 

beneficiary’s prescribed drug. Finally, generic substitution means that 

when there is a generic substitute available, the PDP will automatically 

provide the generic, unless the beneficiary’s doctor specifically orders the 

brand-name drug. 

 13MMA requires that formularies include at least two drugs in each approved category and 

class (unless only one drug is available for a particular category or class). MMA 117 Stat. 

2085 and 69 Fed. Reg. 46,632, 46,660 (Aug. 3, 2004). Formularies often consist of different 

“tiers,” which are categories of drugs grouped according to their cost. 

1442 C.F.R. § 423.578(b) (2005). 

1542 C.F.R. § 423.580 (2005). 

Page 8 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
To help cover costs under Part D, Medicare provides subsidies to certain

low-income beneficiaries. For example, Medicare beneficiaries for whom 

Medicaid16 pays their Medicare Part B17 premium automatically receive the 

full low-income subsidy. This subsidy provides the beneficiary with 

reduced copayment amounts, covers any deductible, provides drug 

coverage during the coverage gap, and helps pay their PDP premium, up to 

a certain amount.18 Other Medicare beneficiaries, however, must apply for

the low-income subsidy through the Social Security Administration, and 

may receive only a partial subsidy. 

For 2006, 79 sponsors are offering over 1,400 PDPs, each of which has 

been approved by CMS to ensure that it meets established standards. Ten 

of these sponsors are offering PDPs in all 34 PDP regions, and they 

account for nearly 62 percent of PDPs nationwide.19 The largest PDP 

sponsors are either in the commercial insurance or pharmacy benefit 

management and services sectors and generally have prior experience 

with call center operations.20 In addition, the largest PDP sponsors all have 

some prior experience with Medicare. Most offered a Medicare 

prescription drug discount card or partnered with a company and most 

offer Medicare Advantage plans.21

Almost all of the calls we placed were answered by a CSR with minimal 

delay. A limited number of calls were not answered by CSRs, mainly due 

to disconnections. Further, we found that most CSRs with whom we spoke 

 16Medicaid provides health care coverage to eligible low-income people and is jointly 

financed by the federal government and the states. 

Characteristics of PDP 

Sponsors 

CSRs Generally 

Provided Prompt, 

Courteous, and 

Helpful Service 

17Medicare Part B provides coverage for certain physician, outpatient hospital, and other 

services to beneficiaries who pay monthly premiums. 

18The amount of the subsidy varies by PDP region and does not cover the entire premium of

all PDPs. Accordingly, not all PDP sponsors have a plan for which the subsidy covers the 

plan’s entire premium. 

19The Henry J. Kaiser Family Foundation, The Landscape of Private Firms Offering 

Medicare Prescription Drug Coverage in 2006 (Washington D.C.: March 2006). 

20Many employer-sponsored health plans and insurers contract with pharmacy benefit 

managers for services such as negotiating price discounts with retail pharmacies, operating

mail-order prescription services, and formulary development and management. 

21The prescription drug discount card was a program authorized by MMA to give 

beneficiaries access to lower-priced drugs from 2004 through 2005. 

Page 9 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
were easy to understand, polite, and professional, and many provided 

helpful suggestions and information. 

Call centers generally provided prompt service in answering our calls. The

wait time to reach a CSR was generally short—46 percent of the 864 calls 

CSRs fielded were answered in less than 1 minute and 96 percent of the

calls were answered in less than 5 minutes (see fig. 1). Only 9 calls 

(1 percent) were answered in 10 minutes or more, with the longest wait 

time being 25 minutes (1 call). For a small number of calls—36 of the 900

calls we placed (4 percent)—we did not receive an answer to our 

questions because we did not reach a CSR. For almost all of these calls 

(33), this occurred because we were disconnected.

22

 22We did not reach a CSR for the remaining three calls due to system errors or because the

calls were misdirected, such as if the interactive voice response stated that the sponsor’s 

call center was closed and that the caller should call back during certain specified hours. 

However, the call had been placed during those hours. 

Page 10 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
Figure 1: Percentage of Calls by Wait Time to Reach a CSR, and Percentage of Calls 

Where We Did Not Reach a CSR, March 2006 

0

10

20

30

40

50

Calls for which we did not reach a CSR

Calls for which we reached a CSR

Did not 

reach CSR

10 or 

more

5 to less

than 10

2 to less

than 5

1 to less

than 2

Less

than 1

Source: GAO.

Percentage

Wait time in minutes

46

35

15

3

1

4

Note: Percentages of calls by wait time to reach a CSR are based on the 864 calls for which we 

reached a CSR. Percentage of calls where we did not reach a CSR is based on the total number of 

calls (900) we placed. 

CSRs generally provided courteous service. Our callers noted that many 

were helpful and friendly, and we found that CSRs were easy to 

understand, polite, and professional in 98 percent of the calls. In addition, 

if a CSR did not know or could not answer a question, many provided 

additional resources for obtaining the answer, most commonly during 

calls on the low-income subsidy (question 3). While CSRs did not provide 

an answer for over one-third of the calls for this question, in over 

80 percent of these cases, CSRs suggested another source the caller could 

contact to obtain the answer—most commonly Medicare or the Social

Security Administration. 

Many CSRs also provided callers with helpful suggestions that related to

our questions. For example, during question 1 calls on the PDP 

comparison for a low-utilization beneficiary, CSRs provided information 

Page 11 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
about a mail-order option to obtain drugs in 22 percent of the calls. For 

question 2 on the PDP comparison for a high-utilization beneficiary, CSRs

provided the caller with information about lower-cost drugs in 41 percent

of the calls and inquired as to whether the beneficiary was eligible for the 

low-income subsidy in 24 percent of the calls. 

CSRs at the 10 PDP sponsor call centers we contacted provided accurate

and complete responses to about one-third of the calls they fielded, 

although the accuracy and completeness rates for each of the 10 sponsor 

call centers and for each of the five questions varied. CSRs were unable to

provide an answer for 15 percent of the questions posed, primarily those 

related to plan costs. In addition, we found that CSRs within the same call 

centers sometimes provided inconsistent responses to our questions. 

Excluding the 4 percent of calls for which we did not reach a CSR, we 

obtained accurate and complete responses to 34 percent of the calls—294 

of 864—and obtained incomplete responses to another 29 percent of the 

calls (see fig. 2). 

PDP Sponsor Call 

Centers Did Not 

Consistently Provide 

Callers with Accurate 

and Complete 

Information 

About One-Third of CSR 

Responses Were Accurate 

and Complete 

Page 12 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
Figure 2: Percentage of Calls with Accurate and Complete, Incomplete, or

Inaccurate Responses, and Those Where No Answer Was Provided, March 2006 

Accurate and complete

Incomplete

Inaccurate

No answer provided

15%

29%

34%

22%

Source: GAO.

Note: Percentages are based on the 864 calls for which we reached a CSR and exclude the 36 calls 

for which we did not reach a CSR. An incomplete answer was not possible for question 3. Calls were 

categorized as “no answer provided” if the CSR stated that they did not know or could not provide an 

answer. 

The overall accuracy and completeness rates for each of the 10 PDP 

sponsor call centers varied widely, ranging from 20 to 60 percent (see 

fig. 3). Only 1 sponsor call center had an overall accuracy and 

completeness rate of greater than 50 percent and 2 sponsor call centers 

had rates of 25 percent or less. No sponsor’s call center consistently had 

the highest or lowest accuracy and completeness rate for all questions. For 

example, although 1 call center had the highest accuracy and 

completeness rate for both question 1 (the PDP comparison for a lowutilization beneficiary) and question 2 (the PDP comparison for a highutilization beneficiary), it had the second-lowest accuracy and 

completeness rate for question 4 (nonformulary drugs). 

Page 13 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
Figure 3: Lowest, Highest, and Average Sponsor Call Center Accuracy and 

Completeness Rate, by Question, March 2006 

Percentage

0

10

20

30

40

50

60

70

80

90

100

Highest accuracy and completeness rate

Average accuracy and completeness rate

Lowest accuracy and completeness rate

Question 5:

Utilization

management

Question 4:

Nonformulary

drugs

Question 3:

Low-income

subsidy

Question 2:

High-utilization

beneficiary

Question 1:

Low-utilization

beneficiary

All questions

Source: GAO.

60

34

20

88

29

0

81

14

0

72

34

6

50

32

6

94

60

6

Note: Percentages are based on the calls for which we reached a CSR and exclude the calls for 

which we did not reach a CSR. We placed 180 calls for each question; we reached a CSR 170 times 

for question 1, 169 times for question 2, 174 times for question 3, 176 times for question 4, and 175 

times for question 5. 

Variation across call centers was due, in part, to differences in the 

resources that CSRs said were available to them. For example: 

• In response to questions 1 and 2, CSRs at two call centers indicated that 

they were able to compute the annual cost of the least expensive plan 

because they had access to a computerized “cost calculator.” However, 

CSRs at other call centers stated that they could not compute an annual 

cost because they did not have access to such a resource. We located cost 

calculators on the Web sites of seven sponsors, each of which had call 

center CSRs who stated that they did not know or could not calculate an 

annual cost. 

Page 14 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
• CSRs at six different sponsor call centers stated that they could not 

calculate the annual cost of the least expensive plan because they did not 

have access to the retail prices of the beneficiary’s drugs.23 In contrast, 

CSRs at two other call centers stated that they did have access to these 

prices, and were able to use them in calculations. 

For each of the five questions, accuracy and completeness rates varied, 

but were generally low. They ranged from 14 to 60 percent (see fig. 4). 

 23In estimating the amount a beneficiary pays annually, information on the plan’s negotiated 

retail price is required, for example, to account for the purchase of any nonformulary drugs

or the purchase of drugs during the coverage gap. In both these instances, the beneficiary

typically pays the plan’s negotiated retail price for the drug. 

Page 15 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
Figure 4: Percentage of Calls with Accurate and Complete, Incomplete, or

Inaccurate Responses, and Those Where No Answer Was Provided, by Question, 

March 2006 

Note: Percentages are based on the calls for which we reached a CSR and exclude the calls for 

which we did not reach a CSR. We placed 180 calls for each question; we reached a CSR 170 times 

for question 1, 169 times for question 2, 174 times for question 3, 176 times for question 4, and 175 

times for question 5. An incomplete answer was not possible for question 3. Calls were categorized 

as “no answer provided” if the CSR stated that they did not know or could not provide an answer. 

Total may not add to 100 due to rounding. 

0

10

20

30

40

50

60

70

80

90

100

No answer provided

Inaccurate

Incomplete

Accurate and complete

 

Source: GAO.

Percentage

8

26

37

29

30

25

31

14

35

31

34

2

50

15

32

2

14

24

60

Question 5:

Question 4:

Question 3:

Question 2:

Question 1:

Utilization

Nonformulary

Low-income

High-utilization

Low-utilization

manag

dru

ement

gs

subsidy

beneficiary

beneficiary

Page 16 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
Relatively few CSRs were able to accurately identify the least costly plan 

and calculate its annual cost.24 In addition, the annual cost estimates that 

CSRs provided were often substantially different from the plans’ actual 

costs. For example: 

• For the low-utilization beneficiary (question 1), about 1 in 3 responses 

were incomplete; that is, CSRs identified the least costly plan, but either 

inaccurately calculated its annual cost or stated that they could not 

provide any annual cost. Over half of the CSRs that provided an inaccurate

response quoted a cost that was greater than the actual cost. 

• For the high-utilization beneficiary (question 2), about 3 in 10 responses 

were incomplete. Among the 23 CSRs that correctly identified the least 

costly plan, but gave an inaccurate annual cost, almost all provided a 

quote that was less than the actual cost, and in 11 cases over $1,000 less.25

About two-thirds of the CSRs were unable to accurately report whether 

the sponsor offered a PDP for which a Medicare beneficiary that received

help from Medicaid would not have to pay a premium (question 3). 

Specifically, CSRs fielding this call answered inaccurately 31 percent of 

the time and did not provide an answer 35 percent of the time. For most of 

the inaccurate answers, CSRs stated that a certain PDP would not require 

a premium from the beneficiary, but, in fact, it would. Other inaccurate

responses showed a poor understanding of the low-income subsidy 

benefit; for example, two CSRs incorrectly stated that the low-income 

subsidy did not help offset the premium at all. 

Half of the CSRs responding to question 4 incompletely described the 

options available to a beneficiary taking a nonformulary drug. Of the 

incomplete responses, about 4 in 5 CSRs mentioned that the beneficiary 

could request an exception to have the plan cover the nonformulary drug, 

 24Inaccurately identifying the sponsor’s least costly plan and its annual cost could have 

financial consequences for beneficiaries because the actual cost differences among 

sponsors’ PDPs were often substantial. In the low-utilization beneficiary scenario, for 8 of 

the 10 sponsors, the cost differences between the least costly and the next-to-least costly 

PDP ranged from $106 to $388 per year. For the remaining 2 sponsors, the differences were 

less than $25. In the high-utilization beneficiary scenario, for 3 of the 10 sponsors, the cost 

differences between the least costly and the next-to-least costly PDP ranged from $517 to 

$2,346 per year. For the remaining 7 sponsors, the differences were less than $200. 

25For question 2 regarding the high-utilization beneficiary, the annual cost of the least 

expensive PDP for each sponsor ranged from $3,659 to $7,122. 

Page 17 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
but not that the beneficiary could switch to a drug that the plan covers.26 In 

addition, 15 percent of CSR responses included neither possibility, with 

many CSRs stating that the beneficiary’s only option would be to pay full 

price for nonformulary drugs. 

Finally, CSRs accurately described at least two utilization management 

tools in 60 percent of our calls for question 5—the highest accuracy and 

completeness rate of our five questions. Other CSRs identified, but could 

not accurately describe, specific tools. For example, one CSR incorrectly 

stated that quantity limits—a limit on the amount of a drug that the plan 

will cover over a certain period of time—means that a pharmacy may not

have enough of a drug to fill the beneficiary’s prescription. 

Overall, CSRs stated that they did not know or could not answer our 

question for 15 percent of the calls. This was most common for the 

questions related to PDP costs (the PDP comparison for a low-utilization 

beneficiary, the PDP comparison for a high-utilization beneficiary, and the 

low-income subsidy). 

For question 2 calls regarding the PDP comparison for a high-utilization 

beneficiary, 30 percent of the CSRs stated that they were unable to tell the 

caller which PDP would cost the beneficiary the least annually. In 

contrast, only 8 percent of CSRs provided this response for question 1 on

the low-utilization beneficiary. This difference in the percentage of calls 

for which an answer was provided is likely due to the added complexity of 

comparing PDPs and calculating the annual cost for a beneficiary using 

eight drugs versus a beneficiary using three drugs. However, reliance on at 

least five drugs is common in the Medicare population.27

Question 3 regarding the low-income subsidy had the highest “no answer 

provided” rate—35 percent. Of the CSRs that did not provide an answer to 

this question, almost all stated that they did not know the subsidy amount 

the beneficiary would receive. Because they did not recognize that 

beneficiaries with both Medicare and Medicaid automatically receive the 

CSRs Did Not Provide 

Answers to 15 Percent of 

Calls, Most Often for 

Questions regarding Plan 

Costs 

 26A few CSRs mentioned that certain drugs (such as barbiturates, which are often used for 

seizure disorders or to relieve anxiety, and benzodiazepines, which are often used to treat 

anxiety and insomnia), are excluded from Part D completely and can never be covered. 

27See Health Affairs—Web Exclusive: Prescription Drug Coverage And Seniors: Findings 

From A 2003 National Survey, April 19, 2005. 

Page 18 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
full low-income subsidy, they could not effectively determine whether that 

subsidy would cover the sponsor’s PDP premiums. 

CSRs within the same call center sometimes provided inconsistent 

responses to our five questions. For example, within each of six different 

call centers, among CSRs who accurately identified the least costly plan 

for the low-utilization beneficiary (question 1), some CSRs calculated an 

accurate annual cost, some calculated an inaccurate annual cost, and 

others stated that they could not calculate an annual cost. In response to 

question 2 regarding the high-utilization beneficiary, different CSRs within 

five call centers identified each of their sponsor’s PDPs as the least costly. 

In addition, in response to questions 1 and 2, CSRs at three call centers 

told us that it was against the sponsor’s policies to identify any of their 

plans as having the lowest annual cost.28 However, other CSRs at each of 

these call centers did not cite this policy and did identify a plan as having

the lowest annual cost. 

In part, these inconsistencies were due to differences in CSRs’ knowledge 

about their sponsor’s plans. For example, CSRs’ varying knowledge related 

to the low-income subsidy question (question 3) produced contradictory 

responses. Within each of the 10 sponsor call centers, different CSRs 

answered accurately, inaccurately,

29 or stated that they did not know or 

could not answer the question. When asked about the options for a 

beneficiary using nonformulary drugs (question 4), different CSRs within

each of 6 sponsor call centers stated that a beneficiary could either switch 

to a covered drug or apply for an exception, stated only that the 

beneficiary could switch to a covered drug, stated only that the beneficiary 

could apply for an exception, or stated neither possibility. Among CSRs 

that stated neither possibility, the specific responses differed. For 

example, at 1 of the above call centers, although five CSRs answered the 

question accurately, one erroneously stated that the beneficiary’s only 

option was to pay full price for nonformulary drugs, and another 

erroneously stated that any drugs not covered by the PDP would be 

covered under Medicare Part B. 

CSR Responses within 

Sponsor Call Centers Were 

Inconsistent 

 28In three of these calls, the CSR further stated that it was the individual’s responsibility to 

determine the least costly plan. 

29Inaccurate responses include CSRs that stated there was one plan without a premium

(when there was not), there was no plan without a premium (when there was), and that

none of the sponsor’s plans had a premium. 

Page 19 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
In answering question 5 on utilization management tools, different CSRs 

within the same call center provided varying descriptions of the utilization 

management tools PDPs use. For example, although four CSRs within one 

call center provided accurate descriptions of at least two tools, three other 

CSRs within this call center each provided a different, and inaccurate, 

description of utilization management tools.30 At another call center, two 

CSRs stated that they could not describe any tools without knowing the 

specific drugs the beneficiary was taking—even though eight other CSRs 

at that call center were able to accurately describe at least one tool 

without knowing the beneficiary’s drugs. 

Our calls to 10 of the largest PDP sponsors’ call centers show that 

Medicare beneficiaries face challenges in obtaining the information 

needed to make informed choices about the PDP that best meets their 

needs. Call center CSRs are expected to provide answers to drug benefit 

questions and comparative information about their sponsors’ PDP 

offerings. Yet we received accurate and complete responses to only about

one-third of our calls. In addition, responses to the same question varied 

widely, both across and within call centers. Sponsor call centers’ poor 

performance on our five questions raises questions about whether the 

information they provide will lead beneficiaries to choose a PDP that costs 

them more than expected or has coverage that is different than expected. 

Rather than consider PDP options solely on the basis of the call centers’ 

information, callers may benefit from consulting other information 

sources available on Medicare Part D when seeking to understand and 

compare PDP options. 

CMS reviewed a draft of this report and provided written comments, 

which appear in appendix I. 

In its comments, CMS characterized our analysis as based on inaccurate, 

incomplete, and subjective methods that limit the report’s relevance and

Concluding 

Observations 

Agency Comments 

and Our Evaluation 

 30Specifically, one CSR at the call center stated that, for drugs subject to utilization 

management, the beneficiary may have to get a new prescription each time they obtain 

their drugs, rather than obtaining refills at the pharmacy. Another CSR at this call center 

stated that, for drugs subject to utilization management, the beneficiary will need a 

prescription for any “addictive” drugs. A third CSR said that utilization management means

that certain drugs may only be covered at select pharmacies and specific strengths of

certain drugs may not be covered. 

Page 20 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
validity. However, CMS went on to say that despite its view on the study’s

limitations, GAO is right to be concerned about whether beneficiaries are 

getting effective service from plan call centers. 

CMS asserted that our questions did not reflect the usual questions 

received by PDP sponsor call centers. As noted in the draft report, we 

selected topics that were addressed in the Frequently Asked Questions 

section of the Medicare.gov Web site and regarded by policy experts and 

beneficiary advocates as important to making an informed plan choice. 

Furthermore, at a May 2006 meeting with CMS officials, the agency’s 

Deputy Administrator stated that CSRs should be able to accurately 

answer all of the specific questions we posed during the study. 

CMS also stated that we asked for information that CSRs are not required

to provide. Specifically, for questions 1 and 2 on PDP comparisons for low 

and high-utilization beneficiaries, CMS stated that it does not require 

sponsor call centers to provide information on the annual costs of their 

PDPs. However, while not necessarily required, agency officials had 

indicated that the information we sought from CSRs was within the scope 

of plan sponsor customer service efforts. In a discussion held before we 

conducted our March calls, CMS officials told us that the agency had not 

established any requirements regarding the specific types of information 

plan CSRs must be able to provide, but that it was reasonable to expect 

CSRs to give callers accurate information on the topics we included in our 

review. 

In addition, as noted in the draft report, some call centers were relatively 

successful in providing accurate and complete answers to questions 1 and 

2, indicating that call center CSRs can handle such questions

appropriately. One call center’s CSRs answered the question accurately

and completely in 88 percent of the calls for the low-utilization 

beneficiary, and one call center’s CSRs responded correctly in 81 percent

of the calls for the high-utilization beneficiary. In addition, we found that 7 

of the 10 PDP sponsors had cost calculators on their Web sites that could 

have been used to answer these questions. 

CMS commented that, to be counted as providing a complete response to 

questions 1 and 2 on PDP comparisons, we expected CSRs to recommend 

a specific plan to the caller, a practice that often constitutes “steering,” 

Page 21 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
which is prohibited under Medicare marketing guidance.31 As noted in the 

draft report, our callers identified themselves as family members wishing 

to assist beneficiaries in choosing a drug plan. Providing assistance to 

beneficiaries—which is encouraged by CMS—generally consists of 

learning the characteristics of various PDPs and assessing their relative 

merits given the potential enrollee’s needs. This is clearly allowed in CMS’s 

Marketing Guidelines, which distinguish between assistance based on 

objective information and steering to a drug plan for financial gain. 

CMS also took issue with how we counted a specific CSR response to 

questions 1 and 2. The agency incorrectly claimed that a CSR’s referral to 

1-800-MEDICARE was categorized as an incomplete response. As noted in

the draft report, we categorized responses as incomplete if the CSR 

accurately named the lowest annual cost plan, but either inaccurately 

calculated or could not provide the annual cost. If the CSR did not answer 

the question and instead referred the caller to 1-800-MEDICARE for 

information on PDPs, we classified the response as “no answer provided.” 

CMS stated that the wording of question 3 on the low-income subsidy was 

inaccurate and therefore misleading. This question specifies that the 

beneficiary automatically qualifies for extra help because Medicaid pays 

part of her Medicare premiums. According to CMS, the wording of 

question 3 is incorrect because only Medicare pays the drug premium for 

low-income beneficiaries and Medicaid would fully (not partly) pay the 

Part B premium. However, CMS’s comment conflicts with the information 

we obtained from its Medicare.gov Web site in developing the wording and 

answer for this question. Using the Web-based PDP finder tool on this Web

site, the user can select one of several options specifying why the 

beneficiary qualified for extra help. We selected the option specifying that 

the beneficiary automatically qualified for extra help because they receive 

“help from [the] State paying Medicare premiums.” We agree that only 

Medicare, and not Medicaid, pays the Medicare Part D premium for lowincome beneficiaries and Medicaid would fully (not partly) pay the Part B 

premium. Therefore, for such a beneficiary, Medicaid would pay part of 

the beneficiary’s Medicare premiums. 

CMS also stated that, for certain questions, many reasonable answers were 

not counted as correct. The agency cited our question regarding a 

 31Steering constitutes an attempt to guide beneficiaries to a specific PDP or group of PDPs 

to further financial or other interests.

Page 22 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
beneficiary’s options should he or she be prescribed a nonformulary drug, 

and asserted that our criteria for a correct response—switching to a 

covered drug or asking for an exception—was too limited. The agency 

stated that other reasonable answers should have been counted as correct 

because we conducted our calls at a time when all plans covered all Part D 

drugs.32 We obtained the answer to this question from a script that CMS 

approved for use by CSRs operating its 1-800-MEDICARE help line. In

addition to the two options we used as criteria for an accurate and 

complete answer, the script mentioned that PDPs are required to provide 

beneficiaries with temporary transitional coverage (generally for 30 days

after enrollment) of drugs not on the PDP’s formulary. However, according 

to CMS, the purpose of this temporary coverage is to provide beneficiaries 

with sufficient time to switch to another drug or to request an exception to 

the formulary. Therefore, in specifying our criteria for an accurate and 

complete answer, we chose to include only the two options that CMS sees 

as longer-term solutions for the beneficiary. 

CMS stated that we did not examine certain features of the support 

services that plan sponsors’ call centers are required to provide, such as 

hours of operation, wait times, disconnection rates, and language services. 

It also noted requirements that plans report a range of performance 

measures, such as beneficiary complaint rates and timeliness of 

exceptions and appeals decisions. As noted in the draft report, the scope 

of our review was limited to the accuracy and completeness of 

information disseminated to the public by PDP sponsors’ call centers—a 

feature of plan customer service for which CMS has established no 

performance requirements. 

Finally, CMS believes that, as written, our study provides little practical 

guidance of value in improving the drug benefit and that our conclusion—

that callers may benefit from consulting other information sources 

available on Medicare Part D when seeking to understand and compare 

PDP options—is obvious. In quoting our conclusion, CMS omitted the key 

part of the paragraph preceding the quoted phrase where we state that 

“sponsor call centers’ poor performance on our five questions raises 

questions about whether the information they provide will lead 

beneficiaries to choose a PDP that costs them more than expected or has 

 32Because all PDPs do not routinely include all Part D drugs on their formularies, we 

assume that CMS’s comment refers to the requirement that all beneficiaries enrolled in 

January or February 2006 receive temporary drug coverage through March 2006, and that 

all beneficiaries enrolled thereafter receive temporary drug coverage for at least 30 days. 

Page 23 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
coverage that is different than expected. . . .” We continue to believe that 

plan sponsors should be accountable for the accuracy of their information 

and make maintaining effective call centers a priority. 

CMS also provided us with detailed, technical comments, which we 

incorporated where appropriate. 

As agreed with your offices, unless you publicly announce the contents of

this report earlier, we plan no further distribution of it until 30 days from 

the date of this letter. We will then send copies to the Administrator of 

CMS, appropriate congressional committees, and other interested parties. 

We will also make copies available to others upon request. This report is 

also available at no charge on GAO’s Web site at http://www.gao.gov. 

If you or your staffs have any questions about this report, please contact 

me at (312) 220-7600 or aronovitzl@gao.gov. Contact points for our Offices 

of Congressional Relations and Public Affairs may be found on the last 

page of this report. GAO staff who made contributions to this report are 

listed in appendix II. 

Leslie G. Aronovitz 

Director, Health Care 

Page 24 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
List of Requesters 

The Honorable John D. Dingell 

Ranking Minority Member 

Committee on Energy and Commerce 

House of Representatives 

The Honorable Henry A. Waxman 

Ranking Minority Member 

Committee on Government Reform 

House of Representatives 

The Honorable Charles B. Rangel 

Ranking Minority Member 

Committee on Ways and Means 

House of Representatives 

The Honorable Sherrod Brown 

Ranking Minority Member 

Subcommittee on Health

Committee on Energy and Commerce 

House of Representatives 

The Honorable Pete Stark 

Ranking Minority Member 

Subcommittee on Health

Committee on Ways and Means 

House of Representatives 

Page 25 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
Appendix I: Comments from the Centers for Medicare & Medicaid Services Appendix I: Comments from the Centers for 

Medicare & Medicaid Services 

Page 26 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
Appendix I: Comments from the Centers for Medicare & Medicaid Services 

Page 27 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
Appendix I: Comments from the Centers for Medicare & Medicaid Services 

Page 28 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
Appendix I: Comments from the Centers for Medicare & Medicaid Services 

Page 29 GAO-06-710 Medicare Prescription Drug Plan Sponsor Call Centers
Appendix II: GAO Contact and Staff Acknowledgments 

Page 30 GAO-06-710

Appendix II: GAO Contact and Staff 

Acknowledgments 

GAO Contact Leslie G. Aronovitz, (312) 220-7600 or aronovitzl@gao.gov 

In addition to the contact named above, Rosamond Katz, Assistant 

Director; Manuel Buentello; Jennifer DeYoung; and Joanna L. Hiatt made 

major contributions to this report. Other contributors include Lori D. 

Achman, Diana B. Blumenfeld, Gerardine Brennan, Laura Brogan, Lisa L.

Fisher, M. Peter Juang, Martha R.W. Kelly, Ba Lin, and Michaela M. 

Monaghan. 

Medicare Prescription Drug Plan Sponsor Call Centers

Acknowledgments 

(290519) 
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