The CMS will follow widely accepted best practices used in the private sector to review drug formularies in administering prescription drug benefits, the agency said in a draft guidance.
According to the guidance, pharmacy and therapeutics (P&T) committees will be required to use best practices to provide appropriate and up-to-date access for beneficiaries. The same philosophy will be used in the CMS' evaluation of drug formularies and benefit management tools.
The guidance includes requiring a majority of members of P&T committees to be practicing physicians or pharmacists, as well as a review of all classification systems of prescription drugs to ensure that plans provide an appropriate scope of categories and classes to cover all disease states. Plans also will be required to provide access to drugs determined to be medically necessary.
The agency is soliciting public comment for final rules to be released in early 2005.