Insurance plans under Medicare Part D must continue to cover those plan participants who are already taking a particular drug even if the drug is removed from their formulary according to a policy announced on April 26, 2006 by the Center for Medicare and Medicaid Services.
If insurance plans change the drugs covered in their formularies, co-pays, or other restrictions plan members already taking those drugs must be exempt from the new rules for the remainder of the plan year.
There are some limited exceptions to the policy including
- Drugs that are shown in new research to be unsafe for some patients.
- When a new, lower-cost generic form of the drug becomes available during the plan year.
At the end of a plan year, individuals have the opportunity to review their coverage and enroll in a different plan if they choose.
Medicare Part D insurance must cover all prescribed cancer drugs (those not given in the hospital or doctor’s office) but insurance plans can limit drugs covered in other categories, as long as they provide coverage with some comparable medications within the category.
Other coverage of the CMS policy change can be found at Kaiser Family Foundation Kaiser Network.
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