There is welcome news for nursing home residents enrolled in the Medicare drug benefit: They can continue to receive coverage for medications, even if a drug plan drops drugs they’re taking from its formulary.
The Centers for Medicare & Medicaid Services disclosed a new policy that restricts plans from discontinuing or reducing coverage of drugs that beneficiaries are now using. There had been concerns that plans would alter their formularies after beneficiaries had chosen plans based on their medications. A plan can still remove a drug from its formulary if research shows the drug is unsafe or if a generic equivalent becomes available, according to the policy.
America’s Health Insurance Plans supports the policy, but it will financially affect insurers, said Karen Ignagni, president and CEO of the group. Pam Walz, director of the Elderly Law Project at Community Legal Services, praised the plan as “good news.” Previously, insurers could change formularies as often as they wanted, as long as CMS approved the changes.
