Disputes

Published 03/06/2024

 

This page provides information for both Pharmaceutical Manufacturers and Part D Plan Sponsors as it relates to the Manufacturer Discount Program and disputes.

These reports are available for review and download in the MDP module in the Manufacturer Payment Portal (MPP) after submission of a dispute has occurred.

Manufacturers can create disputes within 60 days of the Quarterly Invoice Receipt Date using the MDP module’s Dispute Builder or they can electronically submit any disputes created manually using the Manufacturer Dispute Submission File format provided by the TPA.

Once the Dispute Submission deadline has passed and a dispute has been upheld, the Part D Plan Sponsor that submitted the successfully disputed Prescription Drug Event (PDE) has 90 days upon discovery (the date the Dispute Disposition Report is received) to submit a corrected PDE to CMS.

For more information on how to submit a dispute please refer to the MDP MPP Manufacturer User Guide and the MDP MPP Sponsor User Guide.

Dispute File Names and Descriptions

Name of Dispute File

Description of Dispute File

Contract Dispute Disposition Report  Report for Sponsors detailing the number of CMS reviewed upheld or denied records for a dispute file.
Dispute Resolution File Report for Manufacturers detailing the number of records within a dispute file that were either upheld or denied after CMS review.
Dispute Return File Report for Manufacturers detailing the number of accepted or rejected records after validation in a dispute file submitted for CMS review.
Dispute Submission File  Report for Manufacturers detailing itemized line items submitted in a dispute for an applicable P Number. This report also details any line items that were marked invalid or failed, based on required information for correlating dispute codes.