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The Centers for Medicare & Medicaid Services (CMS) imposed intermediate sanctions on SilverScript Insurance Company to stop enrollment and marketing. SilverScript plans currently have the third-largest membership in the region. SilverScript Insurance Company is a subsidiary of CVS Caremark and provides its Medicare Prescription Drug Plans.

SilverScript is the plan sponsor of three national prescription drug plans:

  • SilverScript Choice
  • SilverScript Basic
  • SilverScript Plus

The sanction means that effective January 15, SilverScript must immediately stop enrollment in and marketing of the plans. The sanction is the result of 2,340 complaints CMS received from January 1-14, 2013, about SilverScript’s operations, a rate CMS says is “four times greater than the rate of complaints received about all other Part D sponsors combined during the same period.” The complaints were about claims not being adjudicated at the point of service such as not paying correctly or at all at the pharmacy, beneficiaries not being enrolled in a plan in a timely manner or enrolled in a wrong plan, and failing to administer the low-income subsidy benefit. According to public statements by SilverScript, the issues resulted from an update to its Part D data systems performed late in 2012.

The issues resulted in CMS determining that SilverScript was substantially out-of-compliance with its Part D operations and therefore imposing the immediate sanctions.

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