Mental Health Part D News Alert

November 22, 2005

Formulary Oversight Process

 
During its first phase of quality assurance (QA) monitoring of prescription drug plan (PDP) formularies, CMS has identified several formularies that do not contain all the required medications.  CMS has stated that these protected medications are not available on their Formulary Finder because of a technical problem when prescription drug plans upload their formulary files onto the CMS website.  Prescription drug plans have already been contacted to correct any problems in their data entry, and deficiencies are being addressed immediately. 

The Medicare Modernization Act requires that “all or substantially all” of six classes of medications (known as “protected” medications) be included on all PDP formularies.  Protected classes include anti-psychotics, anti-depressants, and anti-convulsants. 

CMS will continue to perform additional reviews to ensure that the Plan and Formulary Finders are working correctly.  Any potential discrepancies on individual prescription drug plan websites or the Plan Finder should be directed to CMS for further investigation.