This page provides important information on prescription drug coverage policies under Medicare, the framework for CMS' review of Medicare prescription drug plan formularies, and instructions concerning formulary file uploads.

CY07 Formulary Guidance
This paper is final guidance on how CMS will review Medicare prescription drug benefit plans to assure that beneficiaries receive clinically appropriate medications at the lowest possible cost.

Formulary Reference NDC File for CY 2007 Formulary Submissions
The Formulary Reference NDC File (FRF) has been updated to include additional part D covered drugs and remove obsolete or excluded drugs based in part on industry feedback.  Attached are two files that relate to this update: 1) the Formulary Reference File with the cumulative list of drugs and 2) the Formulary Reference File Change Report containing a list of drug record changes since the last posted Reference File dated March 17, 2006.  This supplementary file features one extra column to indicate the type of change as either a record addition or deletion from the Formulary Reference NDC File.

Click the selection that best matches your informational needs.  Please check back as we will continue to update these resources regularly.

Downloads
Formulary Change During the Plan Year [PDF, 72KB] Part D Drugs/Part D Excluded Drugs (v04.19.06) [PDF, 55KB] CMS Clarification of Coverage of Prescription Niacin [PDF, 12KB] Final CY07 Formulary Guidance [PDF, 66KB] CY07 Formulary Reference NDC File (v03.27.06) [Zip, 238KB] FAQ CY07 Formulary Reference NDC File (v03.01.06) [PDF, 23KB] CY06 Formulary Update Cover Note [PDF, 58KB] CY06 Formulary Update [PDF, 13KB] CY06 Formulary Review Guidelines [PDF, 100KB] Clarification Formulary Review - "All or Substantially All" [PDF, 30KB] Pharmacy Technical Support Contact Infomation (v03.02.06) [ZIP, 117KB] Exceptions and Appeals Contact Information (v03.01.06) [ZIP, 181KB] Medicare Prescription Drug Coverage Provider Communication Form [PDF, 23KB] RB Providers Letter [PDF, 249KB] Model Coverage Determination Request Form for Enrollees(4-13-06) [PDF, 23KB]    - Instructions Model Coverage Determination Request (2-7-06) [PDF, 15KB]
Related Links Inside CMS
Medicare Part D Coverage Determination Request Form Parts B & D Information Transition Guidance View the Complete Formulary For a Plan Part D Formulary Information for Physicians
Related Links Outside CMS
The United States Pharmacopeia (USP)

Page Last Modified: 05/04/2006 3:46:00 PM
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