CMS rule guarantees Part D continuity
CMS has ruled that when Medicare Part D plans impose newrestrictions or eliminate a drug from their formularies, they mustcontinue coverage for the remainder of the year on anybeneficiaries who were already taking the medication.
CMS has ruled that when Medicare Part D plans impose new restrictions or eliminate a drug from their formularies, they must continue coverage for the remainder of the year on any beneficiaries who were already taking the medication. There are some exceptions to the continuity-of-coverage rule, such as the removal of a formulary drug found to be unsafe or the addition of a low-cost generic drug that becomes available. Congressional Democrats and a few Republicans had criticized as unfair that drug plans can change formularies at will but most beneficiaries are locked into a plan for 12 months.
Newsletter
Pharmacy practice is always changing. Stay ahead of the curve with the Drug Topics newsletter and get the latest drug information, industry trends, and patient care tips.
