tci Medicare Compliance & Reimbursement - 2005 Issue 6

Health Plans: Formulary Regs Open The Playing Field For Health Plans

New guidelines should be easier to swallow as plans gear up for Medicare Part DIf health plans want to offer a Medicare drug plan, it will need to include 146 types of prescription drugs.That's the message sent by U.S. Pharmacopeia, which issued its final formulary guidelines Jan 3. The Centers for Medicare & Medicaid Services will use the guidelines in assessing plans' drug offerings, and any plan that uses USP's categories and classes will enjoy a statutory "safe harbor," preventing CMS from charging that the plan's formulary discriminates against certain beneficiaries on the basis of their...

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