US · guidance
CMS Pub. 100-18, ch. 6, § 30.3.4.2
Notice for Other Entities
Prior to making any negative formulary change during the contract year, a Part D sponsor must
provide at least 60 days’ notice to CMS, State Pharmaceutical Assistance Programs (as defined
in 42 CFR §423.454), entities providing other prescription drug coverage (as described in 42
CFR §423.464(f)(1), authorized prescribers, network pharmacies, and pharmacists prior to the
date such change becomes effective.
To the extent possible, sponsors may elect to provide State Pharmaceutical Assistance Programs,
entities providing other prescription drug coverage (as described in 42 CFR §423.464(f)(1),
authorized prescribers, network pharmacies, and pharmacists an annual notice providing
information on the sponsor’s formulary change policy (i.e., length of notice, methods of
communication with beneficiaries, and any electronic notices providers may receive at the point-of-sale regarding formulary status) and the sponsor’s Web site where these entities can verify the
formulary status of particular drugs.
History
(Rev. 18, Issued: 01-15-16, Effective: 01-15-16; Implementation: 01-15-16)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-09-17
- Edition
- iom-2026-09-17
- Content hash
b9461f5408661fdbd64728ae58a40abd4452194158c36f4be273a309c7d932d5
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