Medicare Drug Coverage:
Formulary and Transition

Background Information

HAP Resources

• Medicare Drug Plan Formularies
• What Drugs Are Not Part D Drugs?
• Part D Appeals Guide This tool provides beneficiaries and advocates with information on the reasons why a Part D Plan may refuse to cover a prescribed drug, as well as step-by-step instructions on how to file an exception or an appeal.
• Helpful Information to Share with Pharmacists Serving Medicare Beneficiaries This tool provides a one-stop resource for helping pharmacists to identify the common reasons that prescription claims for Medicare beneficiaries are being denied by Part D plans.  The guide also offers step-by-step solutions for each issue. 

CMS Resources

• Chapter 6 of the Prescription Drug Benefit Manual
• Summary - Final Formulary Guidance Changes from Draft
• Guidance on Medicare Part B Versus Part D Coverage Issues
• Transition Guidance
• Model Notice: Final Model Transition Letter
• Reminder on the Part D Best Available Evidence Policy

Other Resources

• USP Model Guidelines for Medicare Part D Plans' Formularies: On December 9, 2005 the United States Pharmacopoeia (USP) released its proposed model guidelines for 2007. These guidelines consist of a list of therapeutic classes that Medicare Part D plans can follow as they create their own drug plan formularies.

CMS Updates

• Formulary and Transition Updates

FAQ

• Formulary FAQ

Training Materials

• Part D Appeals Guide This tool provides beneficiaries and advocates with information on the reasons why a Part D Plan may refuse to cover a prescribed drug, as well as step-by-step instructions on how to file an exception or an appeal. 

Conference Calls

January 17, 2007: At the Pharmacy Counter- Helping Beneficiaries Get Their Prescriptions

February 22, 2006: More Solutions

January 18, 2006: First Aid Kit for Part D