The Medicare Prescription Drug Plan Formulary

Abstract

Managed care pharmacists are involved formally with the interface between the delivery and financing of health care; their work thus entails an accountability for both elements. Interpreted broadly, managed care pharmacists are pharmacists working within the sphere of a health care system, health care purchaser, health insurer, managed care organization, or benefit administration agency. Patients, the pharmacy profession, and society are best served by this broad interpretation, because the interdependency of financing and delivery is inextricably linked to the achievement of good health outcomes. This continuing feature will explore contemporary issues facing managed care pharmacists.

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References

Teagarden

Perspectives on Prescription Drug Benefit Formularies.

Hosp Pharm. 2004; 39(11): 1102–1105.

Centers for Medicare and Medicaid Services (CMS), HHS.

Medicare program; Medicare prescription drug benefit. Final rule.

Fed Regist. 2005; 70(18): 4193–4742.

Medicare Modernization Act Final Guidelines – Formularies. Centers for Medicare and Medicaid Services. Available at: http://www.cms.hhs.gov/pdps/FormularyGuidance.pdf. Accessed on June 16, 2005.

Daniels

, Sabin

J.E.

Setting Limits Fairly: Can We Learn to Share Medical Resources? New York City, NY: Oxford University Press; 2002.

Huskamp

H.A.

, Keating

N.L.

The New Medicare Drug Benefit: Potential Effects of Pharmacy Management Tools on Access to Medications.

The Henry J. Kaiser Family Foundation. Available at: http://www.kff.org/medicare/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=40660. Accessed on June 16, 2005.

Davis

“Tough but Fair?” The active management of the New Zealand drug benefits scheme by an independent Crown agency.

Aust Health Rev. 2004; 28(2): 171–181.

Medicare Modernization Act. Available at: http://www.cms.hhs.gov/medicarereform/. Accessed on June 16, 2005.

Medicare and the letter “S”: how restricted will formularies be?

The Pink Sheet. November 24, 2003: 6–7.

USP drug classification system suggests at least 348 drugs on formularies. The Pink Sheet. September 6, 2004: 17.

10.

Medicare Model Guidelines. United States Pharmacopeial Convention, Inc. Available at: http://www.usp.org/healthcareInfo/mmg/. Accessed on June 18, 2005.

11.

Clarification – Formulary Review. Centers for Medicare and Medicaid Services. Available at: http://www.cms.hhs.gov/pdps/formularyqafinalmmrevised.pdf. Accessed on June 18, 2005.