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2009 Part D plan instructions

Executive Summary

Final version of CMS "call letter" to potential Part D sponsors outlining requirements for the 2009 benefit year reiterates most of the drug-related policies set out in the draft version released in January (1"The Pink Sheet," Jan. 28, 2008, p. 27). To increase transparency on prior authorization requirements, the final call letter requires that sponsors compile such criteria in a standardized format and post it on plan Web sites. CMS will no longer allow plans to impose prior authorization requirements for Roche's HIV therapy Fuzeon (enfuvirtide), nor will the agency permit gap coverage to be limited to mail order drug purchases. In one change, CMS backs off the proposed requirement for electronic prescription reporting in 2009 and announces it will not make such reporting mandatory until 2010

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