CMS rule guarantees Part D continuity

May 22, 2006

CMS has ruled that when Medicare Part D plans impose newrestrictions or eliminate a drug from their formularies, they mustcontinue coverage for the remainder of the year on anybeneficiaries who were already taking the medication.

CMS has ruled that when Medicare Part D plans impose new restrictions or eliminate a drug from their formularies, they must continue coverage for the remainder of the year on any beneficiaries who were already taking the medication. There are some exceptions to the continuity-of-coverage rule, such as the removal of a formulary drug found to be unsafe or the addition of a low-cost generic drug that becomes available. Congressional Democrats and a few Republicans had criticized as unfair that drug plans can change formularies at will but most beneficiaries are locked into a plan for 12 months.