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drug formularies, claims and billing, credentialing, contracting, and collecting and reporting quality data. Reflecting contemporary healthcare management and policy issues, it details how the value of pharmaceuticals is assessed by health plans and PBMs, and discusses how value-based formularies are developed and managed. In June 2005, CMS directed that Part D formularies include all or substantially all drugs in the following six drug classes: antidepressant; antipsychotic; anticonvulsant; immunosuppressant (to prevent rejection of organ transplants); antiretroviral (for the treatment of infection by retroviruses, primarily human immunodeficiency virus; and antineoplastic (only those chemotherapy drugs that are generally are not covered under Medicare Part B). |
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