tci Medicare Compliance & Reimbursement - 2004 Issue 36

Drug Benefit: Proposed Formulary Poses Problems For Plans, PBMs

Number of drug categories will make it tough to contain costs, groups say.With the Part D drug benefit less than 16 months away, health plans need to start thinking about how they're going to design their Medicare drug packages.On Aug. 19, the United States Pharmacopeia released its draft guidelines for evaluating health plans' Medicare drug packages. Though they are only guidelines, insurers would do well to take a close look at them, as any plans' drug package would likely receive federal approval if it followed the USP blueprint, explains John Gorman of Gorman Health Group in Washington...

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