Part D changes for 2013 will put pressure on P&T committees: Drug utilization reviews and medication therapy management programs under the gun

摘要

Starting next year, Medicare will be tightening the screws on formulary decision-makers and P&T committees for Part D drug plans. The Centers for Medicare & Medicaid Services (CMS), which administers the Medicare program, is worried about abuse of controlled substances. This concern will result in a major change in operations for Medicare's Part D drug program in 2013. Both stand-alone Prescription Drug Plans (PDPs) and Medicare Advantage plans with a Part D component (MA-PD) will have to tighten up drug utilization reviews (DURs) for opioid analgesics at a minimum and probably for all drugs. Part D plans will als5 have to galvanize medication therapy management (MTM) programs because the CMS will start publicizing the performance of MTM services next year.