tci Medicare Compliance & Reimbursement - 2005 Issue 4

Drug Coverage: Plans And PBMs Cheer, Big Pharma Jeers Guidelines

CMS chooses a compromise for the new Part D formulary.On Jan. 3, the United States Pharmacopeia released its final drug-classification guidelines for Medicare Part D formularies, and the result pleased insurers and pharmacy benefit managers significantly more than it pleased drug manufacturers. In the Medicare Modernization Act, Congress tasked USP, a private, non-profit standard-setting organization, with developing drug categories and classes that could be used by Medicare drug plans in developing their formularies. Any plan that uses USP's categories and classes will enjoy a statutory "safe harbor," preventing the Centers for Medicare and Medicaid Services from charging...

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