USP Formulary Guidelines Back In Spotlight With Essential Health Benefits Proposal
HHS proposes to use USP’s drug classification system, created as a guideline for Medicare Part D formularies, to facilitate “review, analysis and comparison” of the breadth of drug coverage offered by individual and small group private insurance plans beginning in 2014.
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Released Oct. 1, the draft update to the USP Medicare Model Formulary Guidelines includes several new classes formed to accommodate novel therapies approved in the last three years, including targeted cancer drugs.
In addition to their use as a reference for Medicare Part D plans, the current guidelines serve as a benchmark for evaluating the formularies of private insurance plans offered through state exchanges.
Although the rule does not adopt the many drug access protections requested by drug industry stakeholders, it does promise forthcoming guidance regarding HHS expectations for the formulary exceptions process that should be followed by exchange plans.