Under the new Medicare prescription drug benefit, drug plans will have a fair amount of discretion in setting formularies. The idea is to encourage competition among drug plans and offer Medicare beneficiaries choice. The Centers for Medicare & Medicaid Services (CMS) will review the benefit designs of drug plan bidders to ensure the beneficiaries have appropriate access to needed drugs.
CMS has released draft guidelines for reviewing prescription drug plan formularies. CMS’ strategy for drug benefit review is designed to promote “appropriate operation of beneficiary protections and formulary oversight that includes access to all Part D covered drugs, while providing flexibility in plan design as expected under the Medicare Modernization Act (MMA).” Public comments are due by Thursday, December 30, 2004.
CMS also released a helpful fact sheet that summarizes the formulary review process.