CMS announces Part D coverage requirements

CMS announced Friday that drug plans providing the Medicare Part D benefit must provide "substantially all" FDA-approved drugs in six therapeutic categories: antidepressant, antipsychotic, anticonvulsant, cancer, immunosuppressant and HIV/AIDS. In other therapeutic classes, plans will be required to provide only two drugs.

CMS named three exceptions: Cancer drug Iressa gefitinib from AstraZeneca (LSE:AZN; AZN) is not required on formularies pending the outcome of an FDA review. HIV drug Fuzeon enfuvirtide from Roche (SWX:ROCZ) and Trimeris (TRMS) must be listed on formularies but may require prior authorization for new users. Fosphenytoin, a generic anticonvulsant, may be left off formularies based on "current, widely used best practices." In addition, either Lexapro escitalopram or Celexa citalopram from Forest (FRX) may be left off formularies since escitalopram is the component of citalopram responsible for the antidepressant effects. ...