Strategic’s team of pharmacists and data analysts will work with CMS to monitor drug updates and evaluate Medicare Part D Plan formularies and benefits to ensure the Part D prescription drug program — offered through Medicare Advantage drug plans and stand-alone prescription drug plans — meets CMS formulary guidelines. These guidelines help to ensure that Medicare beneficiaries receive clinically appropriate medications at the lowest possible cost and that Part D plans do not have formularies that discriminate against beneficiaries.
Video: Medicare Part D Formulary
Medicare Part D and Dual Eligibles: Prescription Drug Formularies and Drugs Used by Dual Eligibles
Medicare drug plans may exclude drugs from formularies or may control drug use in an effort to contain costs, but they must meet certain criteria in doing so. Each PDP and MA-PD drug formulary is reviewed by staff in the Centers for Medicare and Medicaid Services (CMS). Generally, Part D plan formularies must cover at least two drugs in every theraputic class. Under CMS rules, Part D formularies must also include all or substantially all drugs in six protected classes: immunosuppressant (for prophylaxis of organ transplant rejection), antidepressant, antipsychotic, anticonvulsant, antiretroviral, and antineoplastic drugs.
Medicare Part D Plans Expanding Five
A review of Part D plan design trends among the leading sponsors shows that Humana has switched to five-tier formularies, UnitedHealth is using a preferred pharmacy network and CVS Caremark is sponsoring plans that include community-based independents in its preferred network.
Medicare Information, Tips to Help You Choose the Right Medicare Plan
Navigating your Medicare prescription drug coverage options can be challenging, but with the right information, you can make the best decision based on your unique medical requirements and preferences. Every patient that is eligible for Medicare is also eligible for prescription drug coverage. There are several plans available, including Medicare Advantage and Medicare Part D plans, so it is imperative to understand your options before making a decision. It may also be helpful to talk to an expert in the field if you have questions or concerns about which plan is right for you. Here are a few tips to keep in mind while evaluating your options for Medicare prescription drug coverage:
Q1Medicare.com Releases Updated Medicare Part D Prescription Drug Plan Formulary Browser
Q1Medicare.com has updated their Medicare Part D Formulary Browser with the latest prescription drug plan formulary data made available from the Centers for Medicare and Medicaid Services (CMS). Since January, the updated data includes the addition of over 70 medications and the deletion of 16 medications that impact all Medicare Part D prescription drug plans. The most recent released June formulary changes include the addition of 20 new medications. A detailed summary of the recent formulary changes impacting all Medicare Part D plans, along with corresponding links to specific formularies can be found within the Q1Medicare.com/Blog.In addition to the major additions and deletions to all Medicare Part D plans, most Medicare Part D plans have adjusted their drug lists with the addition of new medications, removal of medications, changes to drug cost-sharing tiers, and changes to specific drug usage management requirements. For example, since the beginning of 2012, over 250 formularies now include the newly introduced generic medication atorvastatin.To review a specific Medicare plans prescription coverage, Q1Medicare site users can access any stand-alone Medicare Part D prescription drug plan or Medicare Advantage plan formulary by using the Formulary Browser found at Q1Medicare.com/FormularyBrowser.The Q1Medicare.com Formulary Browser is designed so the Medicare community can quickly find a Medicare Part D plans drug list by just selecting the state or entering a ZIP Code, the name of the Medicare Part D plan carrier, and then selecting the name of the specific Medicare plan. Once a Medicare plan is selected, the user can then browse alphabetically for a specific medication. The Formulary Browser provides search results in a chart with the medication drug strengths and packaging; formulary drug tier details; preferred pharmacy and mail-order cost-sharing or co-payment amounts; and drug usage management restrictions. The formulary information also includes details about the Medicare prescription drug plans monthly premiums, initial deductible and whether the plan qualifies for the state-specific Low Income Subsidy $0 monthly premium.Pharmacists, prescribers, and healthcare professionals can also access Medicare prescription drug plan formularies by selecting the PlanID tab and search by plan Contract/Plan IDs or by selecting the FormularyID search tab and entering the plans unique eight-digit Formulary ID. As a convenience, both the Contract/Plan ID and the Formulary ID search results will return the geographical service area for the chosen Medicare plan along with the Medicare plans formulary details and the actual Medicare plan features.We developed our Formulary Browser so people could quickly see the details for the prescription drugs covered by a specific Medicare Part D plan, notes Dr. Susan Johnson, Technical Director and co-founder of Q1Group LLC. Aside from our recent drug data update, we have also enhanced our Formulary Browser by linking it with our Drug Finder so that with one click, users can see how all Medicare plans in the area cover a particular medication.The Q1Medicare Formulary Browser and Drug Finder are both available at no cost and designed for computer, smartphone and tablet platforms. The results of the Formulary Browser and Drug Finder are also formatted to be printed for offline use.About the Q1Medicare.com Website Q1Medicare.com is one of the largest independent online resources for Medicare Part D prescription drug plan and Medicare Advantage plan information. Q1Medicare offers a large selection of Frequently Asked Questions, online tools, and a free Medicare Part D Newsletter all designed to help Medicare beneficiaries, healthcare professionals, advocates, advisers, caregivers, and insurance agents better understand both the Medicare Part D prescription drug and Medicare Advantage programs. Q1Medicare.com is operated by Q1Group LLC (Saint Augustine, Florida).
Medicare Part D, formularies, competition, pricing leverage and getting it all wrong
Medicare Part D has long presented a controversy because the law prevents direct negotiation by the government with drug companies for lower prices and rebates; something common in the private sector via pharmacy benefit managers (PBMs). Rather, each Part D provider must negotiate on its own, but with so many vendors offering Part D benefits their negotiating power is limited. In New Jersey for example there are eighteen different vendors offering Part D plans to 1,336,988 Medicare beneficiaries. That is an average of less than 74,277 individuals per vendor (some beneficiaries have private drug coverage through previous employers). How much more pricing leverage would there be if there were only three or four Part D insurers in NJ (or nationally)? In addition, these vendors are prevented from limiting their formulary drugs.
Is There A Limit As To How Many Drugs A Medicare Plan Covers?
The United States Government mandates, by category, the number of drugs covered by each Medicare Plan. For example: If the mandated number for blood pressure medicines is 100, the insurance company must offer 100 different blood pressure medications. This formula applies for all drug categories. The company compiles a list of drugs offered, identified as a “Formulary.” Each insurance plan has its own Formulary. Formularies can, and do, change from year to year. Insured individuals are responsible for finding a plan with a Formulary that supplies the drugs needed.
Part D Formulary Is Key To Choosing The Right Plan
My dad had to move from Ky to GA so my sister and I could take care of him. Humana (his Part D) just terminted him for the month of Dec because he moved out of his service area. They mailed us a letter on 11/25/10(Thanksgiving) and it stated as of 11/30/10 he would no longer have Part D coverage. I spent almost all day last Friday talking to Humana and got no where. They did deduct his payment from his SS??? Any suggestions? Is there a plan that would cover him in GA and KY should he decide to move back and stay with my other sister???