CMS: Part D formularies must include drugs in six categories

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Part D prescription drug plans must include in their formularies all or nearly all drugs in the antidepressant, antipsychotic, anticonvulsant, anticancer, immunosuppressant and HIV/AIDS categories, the Centers for Medicare & Medicaid said last week.

Agency officials explained on the CMS Web site last Friday that a beneficiary should be allowed to continue taking a drug within these categories after signing up with any PDP if the drug has demonstrated positive outcomes. PDPs' formularies should have a majority of the drugs in the six categories so beneficiaries have uninterrupted access.

The formulary requirements for the six categories are consistent with common private-plan formularies and Medicaid coverage policies in most states, CMS said.

The Q&A document is available under the coverage/formulary heading at the following Web site: