• Government
• Profession
• Business
• Opinion
• Health

• Health reform
• H1N1
• P4P
• EMRs
• Medicare
• Liability
• AMA House
• » More

• Book Excerpt
• Business Pitch
• Meetings
• » More

• Contract Language
• Ethics Forum
• In the Courts
• Practice Management
• Technically Speaking
• » More

• Issue dates
• Regions
• Health plans
• Sections
• News briefs
• Columns
• Editorials
• Letters
• Writers
• Other years

• Search tips
• E-mail alert
• Radio
• RSS
• Mobile
• Subscribe
• Institutions
• Staff directory
• Advertising
• Permissions
• Reprints
• News media
• Site guide
• Useful links
• About
• Premium
• Contact

CMS urges limits on Part D drug changes

Doctors and other patient advocates welcomed the agency's formulary guidance but warned that drug plans might disregard the advice.

By David Glendinning, amednews staff. May 22/29, 2006.

• PRINT|
• E-MAIL|
• RESPOND|
• REPRINTS|
• SHARE

Washington -- The Centers for Medicare & Medicaid Services has stepped in to head off what some physicians were worrying would be a major "bait and switch" by some insurers offering Medicare drug plans.

Under voluntary guidance recently issued by CMS, the government states that plans deciding during the middle of the year to stop covering certain drugs should continue for the remainder of the year to pay for the medications for enrollees who already are taking them. Medicare statute allows insurers to drop medications from their formularies or move them into nonpreferred status as long as they receive CMS approval and give 60 days notice before making the change.

The original policy had provoked criticism from physicians, lawmakers and consumer advocates who said plans could offer an attractive array of covered drugs during the enrollment period and then jettison the more expensive therapies after many people already had signed up.

Medicare beneficiaries are allowed to change their drug plans only once a year, during an open enrollment period that begins each fall and that affects coverage for the following calendar year. Democratic lawmakers have been working on legislation that would prevent seniors from having their covered drugs dropped.

The CMS announcement is a welcome development for doctors, said AMA Trustee Edward L. Langston, MD, a family physician in Lafayette, Ind.

"We were trying to get CMS to say that if you're signed up for the program and you're on a covered medication, you ought to be able to continue it through the end of the year," he said. "So from the AMA's perspective, this is a very appropriate directive. It does answer the question of whether they can bait and switch."