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Formulary

• Part D Plan Formulary Changes During the Year

  Between March 1 and October 15 each year, Part D plans have the limited authority to remove drugs from their formulary, or move them to a higher cost tier.

• February 2008 CMS Formulary Guidance: This CMS Memorandum guides plans on imposing stricter prior approval requirements on drugs in their formularies and discusses formulary changes when drugs previouslty available only by prescription become available over-the-counter. Remember that because over-the-counter medications do not require a prescription, these are not Part D drugs.

• CMS Guidance on Mid-Year Formulary Changes (2007)

  In this guidance, CMS explains the types of formulary changes that are permitted during this mid-year period. This Memorandum (18Kb PDF file) contains many useful tips about Part D formulary changes.

• Exceptions and Appeals
  • Plan Contacts

    This list contains contact information for the person or unit responsible for exceptions and appeals at every Part D plan.

  • Flow Chart

    This flow chart (14Kb PDF file) from CMS detaild the procedures and timelines for a Part D exception and appeal

• CMS Part D Plan Formulary Guidance for 2007

  The Centers for Medicare & Medicaid Services released these guidelines (35Kb PDF file) in March 2007 for reviewing prescription drug plan formularies and procedures.