Payment appeals.

Medicare Part D plan sponsors may appeal program integrity prescription drug event record review audit determinations. (a) Issues eligible for appeal. (1) CMS's application of Part D policy(ies). (2) Factual or data errors. (b) Issues ineligible for appeal. (1) The Part D plan sponsor's failure to submit documentation in the timeframes specified by CMS during the audit. (2) The program integrity prescription drug event record review audit methodology. [91 FR 17594, Apr. 6, 2026]