Posted 8 years 106 days ago ago by Pat
Part D plans commonly use a variety of prescription drug benefit management tools, including:
• Step therapy: One or more similar lower cost drugs must be tried before other more costly drugs are tried, if necessary.
• Prior authorization: Requires the doctor to contact the plan before the plan will cover these prescriptions. The doctor must show the plan that the drug is medically necessary for it to be covered.
• By law, Part D plans are permitted to cover any prescription drugs and biologicals that:
◦ Must be covered by states that provide Medicaid prescription drug benefits
• Many Part D plans do not cover all of these drugs because in some cases several similar drugs are available to treat the same medical condition.
• Part D plans include the drugs they will cover on formularies that are developed by pharmacists, doctors, and other experts.
• Part D plan formularies must include:
◦ At least two drugs in each therapeutic category
◦ Generic and brand-name drug
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