USP Medicare Guidelines for Medicare Only, AMCP Urges

For Immediate Release
 

Alexandria, VA, October 31, 2013 — The Academy of Managed Care Pharmacy (AMCP) has asked the United States Pharmacopeia (USP) to urge the federal government to use the newly announced USP Medicare Model Guidelines v6.0 for Formulary Categories and Classes with just Medicare populations, not with younger populations in the commercial marketplace. This recommendation was one of several made in an Oct. 30, 2013, letter from AMCP CEO Edith A. Rosata, RPh, IOM, to USP.
 
AMCP also supports linking the categories and classes to RxNorm in the National Library of Medicine database and regularly updating RxNorm Concept Unique Identifier as new medications become available for Medicare Part D coverage. Finally, USP should provide specific guidance on when single medications are assigned a unique class, because the current process does not seem to provide a consistent approach. Excerpts from AMCP’s letter follow:
 
“AMCP would like to emphasize that the model guidelines were designed for use in the Medicare Part D program and as a result are not necessarily appropriate for use in the health insurance marketplaces to provide benefits to a younger population whose needs differ from the senior and disabled populations served by the Medicare program. AMCP has found shortcomings in the use of the model guidelines even in the Part D program. As a result, continued use in the commercial market could be even more problematic. Therefore, AMCP will continue to work with the Centers for Medicare and Medicaid Services (CMS) and others to discourage use of the Medicare Model Guidelines in the commercial insurance market and encourages USP to communicate this message to CMS.”
 
"AMCP also supports linking the categories and classes to RxNorm in the National Library of Medicine database. This will then facilitate plans’ use of the guidelines to link directly to the national drug code (NDC), or medication and package specific information. AMCP is also concerned that updated information in the model guidelines is not always readily available to the public. AMCP supports the publication of this information in a publicly available file rather than the current proprietary format."
 
"AMCP recommends that USP update the RxNorm Concept Unique Identifier (RxCUI) as new medications become available for Medicare Part D coverage. Once available, new RxCUIs should then be posted to the USP website.”
 
"Finally, AMCP is concerned that USP does not provide clear guidance in the model guidelines as to the mechanism for determinations related to whether a medication qualifies as a unique class. For example, the model guidelines often reflect mechanism of action, disease state or condition, or other means to identify medications for a single class. This approach makes it difficult for plans to establish meaningful formularies that ensure access to necessary and appropriate medications at appropriate costs. AMCP seeks to continue to work with USP in the future to refine this process for drug class identification."
 
To read AMCP’s letter in its entirety, click here.
 
About AMCP  
The Academy of Managed Care Pharmacy is a national professional association of pharmacists and other health care practitioners who serve society by the application of sound medication management principles and strategies to improve health care for all. The Academy's nearly 7,000 members develop and provide a diversified range of clinical, educational and business management services and strategies on behalf of the more than 200 million Americans covered by a managed care pharmacy benefit. It is celebrating its 25th anniversary in 2013. More news and information about the Academy can be found at www.amcp.org. 
 
 
For more information, please contact:
Kevin Bruns | kbruns@amcp.org 703-683-8416 ext. 656