News
Article
On Wednesday, August 29, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a memo to Medicare Part D plans that will allow these plans to implement “indication-based formulary design” starting in 2020.
Currently, if a Part D plan includes a specific drug on its formulary, the plan must cover that drug for every FDA-approved indication, or patient condition, even if the plan would otherwise instead cover a different drug for a particular indication.
The CMS memo states that if a Part D plan limits formulary coverage of a drug to certain indications, the plan must ensure that there are other therapeutically similar drugs on formulary for the drug’s non-covered indications.
The ACCC policy team is currently reviewing this policy change.
Read the CMS memo to Part D plans.
Read the agency's fact sheet.
Posted 8/29/2018