Medicare Part D

Medicare Advantage drug plans (MAPDs) and prescription drug plans (PDPs) face tightening compliance requirements at the same time they are confronted by a shrinking pool of eligible enrollees and qualified sales agents, an expanding number of competing plans, and pressure to control costs. UL works with health plans to assure the compliance and productivity of employees, brokers, agents and downstream entities defined by CMS.

KnowledgeWire^®, our robust learning management system meets the "Best Practice" recommendations from CMS. The system allows for the distribution, validation of receipt by e-signature, testing and documentation of all training activities in audit-ready format. Our hosted solution enables non-employees to access training without passing through the company’s firewall, ensuring both optimal security and control over infrastructure use.

Our library of health care-specific courses complies with CMS requirements and targets those areas that the CMS has identified as posing a particular risk of noncompliance. Courses are constantly updated to reflect the most current CMS requirements, such as the 2009 requirement that all compliance programs include training about fraud, waste and abuse. Additional courses focus on related issues, including the False Claims Act, ethics and integrity, human resources, and employee protections, as well as compliance issues regulated by other agencies, such as the SEC and OSHA. Customized courses focus on company-specific needs, such as codes of conduct, corporate policies and procedures, and regulatory updates.

UL has developed a specialized curriculum to address the industry’s specific sales and marketing requirements and regulations. The intensive scrutiny focused on health plan sales and marketing organizations has led many leading Part D companies to implement enterprise-wide training programs to assure enrollee satisfaction and risk management. Topics of particular importance include plan-specific features and limitations; patient confidentiality; and professional relationships with downstream entities, including pharmaceutical companies, doctors and other medical professionals, pharmacies and pharmacy benefit managers (PBMs). Our training materials incorporate advanced instructional design techniques, including simulation, interactivity and gaming to promote interest, engagement and comprehension.

UL helps companies meet both compliance and performance goals related to such issues as:

• MAPD, PDP, and PFFS compliance training;
• Broker and agent training;
• Fraud, waste and abuse (FWA);
• Hotlines to report FWA or other violations;
• False Claims Act;
• Plan-specific training;
• Financial relationships with downstream entities.