Forum Session

Implementing the Formulary Requirements Under the New Medicare Prescription Drug Benefit
December 1, 2004


Dawn M. Gencarelli


This meeting provided an overview of the requirements that will apply to plans (both stand-alone drug plans and Medicare Advantage plans) in the development and application of their drug formularies under the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 for the new Part D drug benefit. It reviewed the oversight role of the Centers for Medicare and Medicaid Services (CMS) and the role of the United States Pharmacopeia in developing model guidelines for drug categories and classes. The meeting also examined the implications of these guidelines on various stakeholders, including beneficiaries, providers, pharmaceutical manufacturers, and participating plans.


Robert Donnelly, MPP, Director, Medicare Drug Benefit Group, Center for Beneficiary Choices, Centers for Medicare and Medicaid Services; Anthony Barrueta, JD, Vice President, Government Relations, Kaiser Foundation Health Plan, Inc., Oakland, CA; Constantine Lyketsos, MD, MHS, Professor of Psychiatry and Behavioral Sciences, Co-Director, Division of Geriatric, Psychiatry and Neuropsychiatry, The Johns Hopkins School of Medicine; Jean Paul Gagnon, PhD, Director of Public Policy, Aventis Pharmaceuticals, Inc.

With comments from:
Charles Clapton, JD, Chief Health Policy Counsel, Committee on Energy and Commerce, Republican Staff, U.S. House of Representatives; Joel White, Professional Staff Member, Committee on Ways and Means, Subcommittee on Health, U.S. House of Representatives; Elizabeth J. Fowler, JD, PhD, Chief Health and Entitlements Counsel, Committee on Finance, Democratic Staff, U.S. Senate

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