tci Medicare Compliance & Reimbursement - 2004 Issue 38

Medicare Advantage: Rules On Formularies, PPOs Raise Concerns

Many questions remain before Medicare reform can be completed. As the Centers for Medicare & Medicaid Services works to finalize regulations for last year's Medicare Modernization Act, the most anxiety from lawmakers and stakeholder groups seems focused on drug-formulary issues, region size for preferred provider organizations, and employer subsidies for retiree drug coverage. Those were the top issues raised by witnesses and lawmakers from both parties at a Sept. 14 Senate Finance Committee hearing on the proposed rules, which were issued this summer. What drugs are on formularies - and how to get those that aren't - will continue...

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