FOR THE 2007 DRUG PLAN CONTRACT YEAR, WILL EXISTING FORMULARY POLICIES REGARDING CERTAIN CLASSES OF MEDICATION BE REVISITED?
The draft formulary guidance for the 2007 contract year will be published soon. There will be a short public comment period, followed by the final guidance in early March. This will address all of the formulary policies for 2007. WHEN A DUALLY ELIGIBLE BENEFICIARY IS ENROLLED (OR ENROLLS) IN THE MEDICARE DRUG BENEFIT PROGRAM, THERE IS A POSSIBLITY THAT HIS OR HER SPOUSE WILL LOSE PREVIOUSLY AVAILABLE PRIVATE COVERAGE. WHAT CAN CMS DO TO ADDRESS THIS ISSUE? ARE THERE STRUCTURAL SOLUTIONS OR IS LEGISLATIVE ACTION NEEDED? Dr. McClellan noted that this situation may affect as many as 70,000-80,000 individuals and that CMS is sending a letter out to remind people that a risk of benefit loss is possible and to suggest they get counseling regarding how best to proceed. At the same time, CMS is working with employers to help resolve this problem for retiree health benefit plans; many have been exceptionally responsive. Generally speaking, it would not be appropriate to eliminate people from th
