USP issues final Medicare drug benefit plan
The list provides a framework for $26.7 billion of Medicare spending on prescription drugs next year in the largest Medicare expansion in the history of the program.
USP, a non-profit Rockville, Md.-based organization, developed the list under terms of the 2003 Medicare law.
The number of categories in the final plan was the same as that proposed Aug. 19 by USP, while the definitions were altered after public comments.
The writing of the guidelines touched off a battle between insurance and drug companies – drug makers wanted as many drugs as possible on the list but insurers want to limit the number and types of drugs.
The guidelines issued on Monday, like a draft issued in August, appear to favor insurers.
Pharmacy benefit managers and other companies are not required by law to follow the proposal. However if they do, each category must include at least two drug options.
Medicare officials still must decide whether to accept the recommendation of USP, the non-profit group that sets drug quality standards. A ruling is expected early this year along with a number of other final rules to move ahead with the Medicare Modernization law passed in December 2003.
"We will use USP's work to make sure that beneficiaries will have access to the prescription drugs they need at the most affordable price," said Mark McClellan, head of the agency that runs Medicare.