CMS To Update Senate Finance Cmte. On Medicare Rx Rules

Committee's Sept. 14 hearing also includes testimony from PCMA, AHIP and Business Roundtable. Issues that could be discussed include USP's proposed drug classification system for Medicare and boundaries for health plan coverage.

Centers for Medicare & Medicaid Services Administrator Mark McClellan leads a panel of witnesses testifying on implementation of the Medicare prescription drug benefit and Medicare Advantage program at a Sept. 14 Senate Finance Committee hearing.

Issues that could surface at the hearing include the U.S. Pharmacopeia's recently proposed model guidelines for categories and classes of drugs covered by drug formularies; development of standardized drug utilization data for plan bidders and health plans' concerns about proposed boundaries for plan coverage.

Another possible topic is whether "fall-back" drug plans will be needed in areas not sufficiently covered by risk-bearing stand-alone plans in 2006. McClellan recently expressed confidence that "there are going to be stand-alone plans everywhere" due to CMS' efforts to ensure sponsor interest (¹ (Also see "Medicare Stand-Alone Rx Plans Will Be Available "Everywhere," McClellan Says" - Pink Sheet, 9 Sep, 2004.)).

The proposed rules for Title 1 (Part D drug benefit) and Title II (Medicare Advantage) were published Aug. 3 and CMS is accepting comments until Oct. 4. The agency expects to release final regulations in February 2005.

The hearing will begin at 10 a.m. in 215 Dirksen Senate Office Building.

[Editor's Note: For the most current information on this and other events, visit "The Pink Sheet" DAILY's Daybook, updated throughout the day.]

Additional scheduled witnesses include Pharmaceutical Care Management Association President Mark Merrit; America's Health Insurance Plans President Karen Ignagni; National Association for the Mentally Ill Executive Director Michael Fitzpatrick; and Business Roundtable Executive Director Larry Burton.

- Salla Hauvonen