CMS: Drug formularies should consider LTC residents' needs

Share this content:

Medicare prescription drug plans should make special drug and formulary provisions for long-term care residents transitioning into the drug program or into a nursing home setting, according to new draft guidance released by the Centers for Medicare & Medicaid.

Plans must provide emergency supplies of non-formulary drugs for beneficiaries transitioning to long-term care settings from other settings. CMS also advises emergency supplies for drugs that are on the formulary but are subject to utilization management requirements as "expeditiously as the enrollee's health condition requires," CMS said in communications with Medicare drug plans.

The revised guidance also requires that plans provide coverage for commonly used dosage forms in long-term care settings, including unit-dose products, liquids, chewables and parenteral preparations, and allowing for at least 31-day supplies for nursing home residents.

CMS is accepting comments on the draft guidance until Sept. 26. To view it, visit