Retiree Drug Subsidy Recovery, Administration, and EGWP Review

RDS Audit, Reopening & Recovery

Most sponsors have never run this audit, simply because they've never had the data required. Our AI-fueled Rx Intelligence Platform compares what your plan actually received in subsidy against the per-capita rate CMS says you're owed. Where the numbers don't match, we review whether the plan year can be reopened and help recover any eligible difference. Think of it as fiduciary due diligence: confirming you're getting the maximum RDS allows, not just what your last filing happened to catch.

RDS Administration

We run your program end to end: application, Covered Retiree List (CRL) uploads, RDS reason code resolution, and reconciliation using CMS's own reconciliation toolkit. We also track Qualifying Covered Retirees (QCR) so nothing drops off the list unnoticed.

EGWP vs. RDS Review

RDS reimburses a share of your actual drug spend, but your plan holds the risk and the annual filing burden. An EGWP shifts that risk, and the administration, to a private carrier for a fixed cost per member. Recent Inflation Reduction Act (IRA) changes added a hard out-of-pocket cap to Medicare Part D, making actuarial equivalence RDS certifications harder for many commercial plans to hit, one more reason this comparison is worth running now. The EGWP vs RDS decision comes down to your real per-member drug spend, not which structure your plan has always used. Our Rx Intelligence Platform, powered by commercial AI trained in healthcare finance, analyzes your numbers, RDS cost thresholds and cost limits, and shows you which option comes out ahead financially.