The formulary, or drug list, is the main source. Unless otherwise specified, the Payment Limit in column D will be applied to payments for drugs infused through covered DME. 20201 COMPLETE DRUG LIST (FORMULARY) Prescription drug list information AARP® Medicare Advantage (HMO) AARP® Medicare Advantage (HMO-POS) AARP® Medicare Advantage Plan 1 (HMO) AARP® Medicare Advantage Plan 2 (HMO) AARP® Medicare Advantage Plan 3 (HMO) Important Notes: This document has information about the drugs covered by this plan. The October 2020 ASP payment limits have been updated. Physicians and other providers should ensure that the units billed do not exceed the maximum number of units per day based on the code descriptor, reporting instructions associated with the code, and/or other CMS local or national policy.Effective January 1, 2017, payment for infusion drugs furnished through a covered item of DME will be based on Section 1847A of the Social Security Act, meaning that most of the payments will be based on the Average Sales Price of these drugs. s�0�> Z`^�a�;�3�si�?��ˏ#�M�T�=��a��A�7��fwgP��}Þ�WˠB��v���ߓp�3k It is possible that you could pay more than the basic premium which is $32.74 per month for 2020. Most Medicare drug plans (Medicare Prescription Drug Plans and Medicare Advantage Plans with prescription drug coverage) have their own list of what drugs are covered, called a formulary. 1018 0 obj <>/Filter/FlateDecode/ID[<59EAE1C4A8989A5C18F96D49A3D265F6><2CDA75BC2643664F8638AE7536C86DB3>]/Index[1005 34]/Info 1004 0 R/Length 73/Prev 78901/Root 1006 0 R/Size 1039/Type/XRef/W[1 2 1]>>stream ��A9ʈx���DZ�!�����8v|��:+����¶m�\�F5Hj0��ƈ�d�i5F�6ސ�l�5Z���xr:7�r��l���S @2�p�"0��,�r��/���o���iŋ�,F�E�w1l�C//3��g/��x2ԫ�Y��97v:w9-7~N��ڐ�l�����հ�bIӁ��;煵ػ ��qG�[:G�2�ꆑ�1=�;��Q7=�%��� The files below contain the payment amounts that will be used to pay for Part B covered drugs for the fourth quarter of 2020. The formulary includes at least 2 drugs in the most commonly prescribed categories and classes. 10J� �:, H�20FwA�}@,��(���t�� @J��1g'D�2@� ��"- We will continue to monitor trends in pricing, as reflected by the published ASP payment rates, as well as utilization within the Medicare community.Where applicable, the payment amounts in the quarterly ASP files are 106 percent of the Average Sales Price (ASP) calculated from data submitted by drug manufacturers. s}�b��W��h����@Jn���8|�0�c�
%%EOF {�}��\�m����u>Ⱦ_��uJ��&]fѬ��(/�Q:��p�M�f���6�������W� ;`�W *�������Z�|X0x�����*���vu�����9��� TQ�j�疠�(t\� Can the formulary (drug list) change? For more up-to-date information … The quarter to quarter price changes are generally the result of updated data from the manufacturers of these drugs.The Medicare Part B payment limits for valid HCPCS codes that are not included in the quarterly ASP pricing files will be determined by the local Medicare contractor.CMS guidance requires physicians and other providers to bill using the appropriate HCPCS or CPT code and to accurately report the units of service. 0 Drug Recall List (PDF) Using your drug list. They list all the drugs covered by your plan. Medicaid Services. �bzy�,�_:k�{�K8@�l�"�f�$���$��E�-���(�(7��U]���ϑ��04f~��X%�� The ASP Drug Pricing Files for 2017 and subsequent years will no longer contain columns for the Infusion AWP or the DME infusion limit.
%PDF-1.4 %���� 1038 0 obj <>stream It does not address all potential situations. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC endstream endobj 1009 0 obj <>stream Choose your plan below to download your drug list. Part B covers 2 types of services. 7500 Security Boulevard, Baltimore, MD 21244