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CMS Extends “Substantially All” Policy In Draft Formulary Guidelines

Executive Summary

CMS plans to continue to require that Medicare Part D plan formularies include "all or substantially all" drugs in six therapeutic classes during the 2007 benefit year, according to draft formulary review guidelines

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CMS Requires Expedited P&T Review For New Drugs In Six Protected Classes

Part D drug plan pharmacy & therapeutics committees must make coverage decisions about new drugs or new indications within 90 days of their entry into the market in Medicare's six "all or substantially all" therapeutic categories, the Centers for Medicare & Medicaid Services states in its final formulary review 1guidelines for the 2007 contract year

CMS Requires Expedited P&T Review For New Drugs In Six Protected Classes

Part D drug plan pharmacy & therapeutics committees must make coverage decisions about new drugs or new indications within 90 days of their entry into the market in Medicare's six "all or substantially all" therapeutic categories, the Centers for Medicare & Medicaid Services states in its final formulary review 1guidelines for the 2007 contract year

Part D Specialty Tier Should Be Reserved For Highest-Priced Drugs – BIO

Too many drugs will be subject to the maximum copay on Part D formularies if CMS allows plans to place all therapies with negotiated prices greater than $500 per month on the specialty tier, according to the Biotechnology Industry Organization

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