Part D Enrollees & Representatives

The Part D Qualified Independent Contractor (QIC), is responsible for conducting reconsiderations of adverse coverage determinations and adverse redeterminations for covered drug benefit or review of an at-risk determination made by Part D plans [stand-alone prescription drug plans (PDPs), Medicare Advantage Prescription Drug Plans (MA-PDs), and cost plans that offer qualified prescription drug coverage], including the amount of cost sharing, if any, that the enrollee is required to pay for a drug.

The Part D QIC’s workload shall also include conducting reconsiderations of adverse determinations related to prior creditable prescription drug coverage/imposition of a late enrollment penalty (LEP) under the Medicare Part D program.