CMS Ruling on Formulary Guidelines Emerges from Rep. Grijalva Supported Legislation

CMS Ruling on Formulary Guidelines Emerges from Rep. Grijalva Supported Legislation

Rep. Raúl M. Grijalva has been working to improve the Medicare Part D Drug Program that passed Congress in 2003.

Among the many efforts was his original co-sponsor of H.R. 5102, the Medicare Drug Formulary Protection Act. The language of that legislation was recently accepted by the Centers for Medicare & Medicaid Services (CMS).

"Today's ruling is a step forward for Medicare Part D beneficiaries," said Rep. Grijalva. "The CMS ruling makes drug plan providers abide by the same rules forced on seniors; for the drug plan provider it means they should not be able to significantly alter the drugs they offer. CMS must enforce this sensible, easy fix that ensures seniors receive the drugs for which they signed up."

Under the Medicare Drug Formulary Protection Act, Medicare prescription drug plans would be prohibited from removing a drug from their formulary until the beginning of each calendar year. If a prescription drug plan wishes to change its formulary, it can do so at the end of the year during the open enrollment period. The plan must notify its enrollees of the formulary changes so seniors can then decide whether to stick with that plan or switch to a different one. The bill also ensures that a drug like Vioxx can be removed expeditiously if it is shown to be harmful.

"I thank CMS for taking the Administrative responsibility to defend our seniors," Grijalva stated. "This ruling corrects one of the obstacles in the Medicare Part D legislation. It is my hope that the CMS with the leadership in Congress work to make the necessary changes, such as extending the May 15th deadline so that seniors have enough time to choose a prescription drug plan that works for them".

http://www.house.gov/grijalva/press/press_releases/pr_042706.html