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Some prescription medications may not be covered under Part D in 2010

Some common prescription drugs usually covered by Medicare Part D may not make the cut in 2010, due to a new policy being implemented by the Centers for Medicare and Medicaid Services.

Starting Jan. 1, CMS is scheduled to begin enforcing its non-matched National Drug Code list policy. At that time any medication not appropriately registered with the Food and Drug Administration will no longer be covered under Part D.

This move that could affect thousands of drugs, including many common prescription products favored by seniors, such as antidepressants, antibiotics, pain relievers and blood pressure and diabetes medicines.

The American Pharmacists Association, Food Marketing Institute, Healthcare Distribution Management Association, National Association of Chain Drug Stores and National Community Pharmacists Association have sent a letter to CMS Acting Administrator Charlene Frizzera addressing the possible effects on patients and pharmacies. It outlines concerns and potential remedies and urges the agency to continue its outreach to stakeholders.

“We strongly encourage you to continue outreach to manufacturers whose products are on the non-matched list as well as Part D plans,” the letter said. “We also strongly urge CMS to consider holding an open door forum as soon as possible in order to capture concerns of all interested stakeholders.”

Ultimately, the ltter said, manufacturers bear the responsibility to register products appropriately with the FDA and with Part D plans to ensure their formularies and edits reflect CMS policies in a timely fashion.

According to the coalition of graoups, denying access to one generic drug will likely increase demand for equivalent generics, which may create a supply shortage – further endangering beneficiary access. In addition, they said, some Part D plans may employ point-of-sale edits at the pharmacy level to block dispensing of unlisted drugs, frustrating patients and pharmacists alike.

The groups recommend that CMS:

  • Either update the non-matched NDC list more frequently or require plans to use the FDA’s NDC list to keep POS edits current.
  • Prohibit retroactive reversal of approved claims for NDCs that appear on the non-matched list. These claim reversals would be unfair to pharmacies that dispensed the medications pursuant to plans’ approval of claims at the point of sale.
  • Issue a standard CMS fact sheet or similar document online to help pharmacists answer beneficiaries’ questions.

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