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Category |
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Medicare Modernization Act
Drug Card Sponsor
First Conference April 7- 8
Monitoring
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Date Created |
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| 06/07/2004 03:23 PM |
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Date Updated |
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| 06/09/2004 03:51 PM |
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What are the rules for drug card sponsors to drop drugs from their formularies? |
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Question |
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What are the rules for drug card sponsors to drop drugs from their formularies? |
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Answer |
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Sponsors may drop drugs from their formularies and change prices weekly. At all times, sponsors must ensure that they are offering discounts on a sufficient number and type of drugs to meet CMS’ baseline formulary requirements. These requirements state that sponsors must offer at least one drug in at least 209 therapeutic categories that represent drugs commonly used by Medicare beneficiaries. Sponsors have a strong incentive to maintain a stable formulary to keep their Medicare beneficiaries satisfied:
·Sponsors need covered lives to negotiate good deals for beneficiaries and to cover their costs of operating the program.
·Satisfied beneficiaries will improve the likelihood that they will stay with the drug card.
·Satisfied beneficiaries will drive a positive association with the card's brand name - this is important for renewed enrollment in 2005 and for the Part D drug benefit in 2006.
·Sponsors need the experience of Medicare beneficiary utilization under the drug card to assist them in understanding their costs and potential risk under the Part D benefit.
CMS will be monitoring changes in the formulary over time.
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