CMS to allow Part D plans to use new formulary tool beginning in 2020

The Centers for Medicare & Medicaid Services Aug. 29 announced that beginning in 2020 it will allow Medicare Part D plans to vary the formulary placement of a drug based on what condition the drug may treat. Today, if a health plan covers a drug, it must cover it for all approved indications unless a particular use is not covered under Part D generally. According to CMS, this flexibility will give plans greater negotiating leverage with drug manufacturers and reduce the prices they pay for drugs. For more information, see the CMS factsheet.
Related News Articles
Headline
A report by the Department of Health and Human Services Office of the Inspector General found that many Medicare Advantage and Medicaid managed care plans…
Headline
Medicare open enrollment for 2026 began Oct. 15 and runs through Dec. 7. During the annual enrollment period, Medicare-eligible individuals can check their…
Headline
The AHA Oct. 3 responded to the Medicare Payment Advisory Commission’s recent analysis on the financial impacts of Medicare Advantage enrollment growth on…
Headline
The federal government shutdown will continue as the Senate Oct. 3 failed to adopt a government funding deal. The latest attempt to pass the House-passed…
Headline
The Centers for Medicare & Medicaid Services Sept. 30 issued a memo, through the Health Plan Management system, finalizing the Medicare Advantage…
Headline
The federal government shut down Oct. 1 following a failed Senate vote on the House-passed continuing resolution to fund the government by midnight Sept. 30.…