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Part D Plans Cannot Offer Separate Long-Term Care Formulary, CMS Says

This article was originally published in The Pink Sheet Daily

Executive Summary

Medicare Rx plans must use the same formulary for long-term care beneficiaries and all other beneficiaries, CMS guidance says. Formularies must cover all "medically necessary medications," which could include alternative dosage forms and intravenous drugs.

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Medicare Part D plans should provide a temporary “first-fill” prescription for new beneficiaries taking non-formulary drugs, CMS says. A 30-day supply “may be reasonable” for most beneficiaries, but for patients in long-term care “a transition period of 90 to 180 days might be appropriate.”

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