C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 423—VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT › Subpart Z—Appeals Process for Part D Program Integrity Prescription Drug Event Record Review Audits

42 C.F.R. § 423.2600

Payment appeals

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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]