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The document outlines proposed information collection activities by the Centers for Medicare & Medicaid Services (CMS) as part of compliance with the Paperwork Reduction Act. It includes requests for public comments on revisions and new collections related to standardized pharmacy notices, medication therapy management programs, and consumer assessments of healthcare providers. Key changes involve the requirement for pharmacies to provide printed notices when prescriptions cannot be filled and the introduction of a standardized format for medication reviews. The document also discusses ongoing surveys to assess healthcare quality and efficiency in Medicare programs.

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What is a formulary in a health insurance plan?

A formulary is a list of all the drugs covered by a health insurance plan. Health plans have different formularies, which means that a particular drug might be covered by one plan in your area, but not by another.

What is the formulary coverage data?

Formulary coverage is a list of generic or brand name drugs. Formulary coverage indicates prescriptions drugs for a specific treatment that are covered by a prescription drug plan or insurance company.

What is the difference between a drug list and a formulary?

Simply put, a formulary is just another name for a drug list. A formulary is the list of generic and brand-name prescription drugs covered by a specific health insurance plan. Sometimes, health plan formularies are also referred to as preferred drug lists (PDLs).

Why did Medicare deny my prescription?

Step therapy: your plan requires you try a different or less expensive drug first. Quantity limits: your plan only covers a certain amount of a drug over a certain period of time, such as 30 pills per month. Off-formulary: the drug is not on your plans list of covered drugs.

What is the excluded drug reference file?

The Excluded Drug Reference File is a list of drugs that may be excluded from coverage under the Medicare Part D program. Similar to the Formulary Reference File, each row on the Excluded Drug Reference File represents a single drug as identified by an RxNorm concept unique identifier (RXCUI).