This blog was prepared by RELI Group. The views expressed are those of the authors and do not represent an official statement, policy, or endoresement by the Centers for Medicare & Medicaid Services.
In April 2025, RELI Group was awarded the Monitoring, Oversight, Compliance and Auditing (MOCA) contract in support of the Centers for Medicare & Medicaid Services (CMS) and its implementation of the new Medicare Drug Price Negotiation Program. As CMS prepares to launch the program on January 1, 2026, RELI is partnering closely with the agency to stand up the systems, teams and processes that will power this major new initiative. We caught up with Brad Hove, MOCA Program Manager, to learn more about the work performed so far to get everything in place for the 2026 launch.
The Medicare Drug Price Negotiation Program represents a fundamental shift in how prescription drug prices are managed for Medicare beneficiaries. CMS and pharmaceutical manufacturers engage in negotiations on certain drugs covered under Medicare Part D pricing agreements to reach an agreed-upon “maximum fair price” that is applied for the Medicare Part D program. The newly negotiated maximum fair prices for the first set of 10 selected drugs will take effect beginning January 1, 2026; CMS is currently in negotiations for the next set of 15 selected drugs, and will continue to select new drugs for negotiation each year as required by the law.
RELI’s role under MOCA is to ensure that several key components of the program are implemented in a compliant and effective manner. That includes:
- Ingesting and investigating complaints related to maximum fair price effectuation
- Monitoring and oversight tasks through the use of data analytics
- Conducting audits of pharmaceutical manufacturers as a key component of CMS’ robust monitoring and oversight of this new program.
As Brad Hove, MOCA Program Manager, put it: “This is a brand-new program, and a unique opportunity to partner with CMS to design everything from the ground up. We’re not inheriting anything. We’re building new systems, new processes and new ways to add value.”
Building the Foundation
RELI is leading the contract as prime, supported by three subcontractors. Since award, much of the team’s energy has gone toward recruiting and onboarding – filling key personnel roles and planning to bring on an additional 20 team members in the coming months.
At the same time, the team is working across a fast-moving five-month timeline to develop standard operating procedures, complaint workflows, internal guidance, training materials and quality assurance measures. “It’s about getting the right people in place and setting up the frameworks to make sure we’re ready on day one,” Brad said.
That preparation also includes a comprehensive data analytics strategy. Complaints will be evaluated using a mix of natural language processing and manual review to inform a risk-based methodology – one that enables real-time dashboards and informs targeted audits and investigations. “Data analytics is going to wrap around everything we do,” Brad explained.
True Collaboration with CMS
One of the most exciting aspects of the work so far has been the spirit of collaboration with CMS. RELI participates in regular technical working sessions and “listen-only” stakeholder calls with pharmacies, pharmacists and manufacturers to better understand potential risks and align processes across the program.
The response from CMS has been encouraging. “We’ve gotten really strong feedback on the SOPs and analytics strategy we’ve submitted,” Brad said. “They’re excited that we’re thinking the same way they are, and that we’re ready to engage as true partners.”
A Mission That Matters
For Brad, a self-described builder, the opportunity to create something entirely new that also serves a meaningful public mission is especially rewarding.
“This program is going to make a real difference for Medicare beneficiaries. It’s a chance to reduce out-of-pocket costs and support better policy through smart oversight. We’re honored to be a part of it.”
The MOCA contract is just one part of RELI Group’s collaboration with CMS to improve health outcomes, reduce costs and protect taxpayer dollars. From standing up new programs like MOCA to helping detect and prevent fraud, waste and abuse across the healthcare system, we’re committed to supporting smarter, more effective government. Read more about our Program Integrity solutions to discover how we strengthen oversight, protect public funds and advance mission-critical programs.
