Doctors say plans are restricting access to Part D formulary drugs

Doctors and pharmacists say many drugs theoretically covered by thenew Medicare drug benefit are not readily available because ofinsurers’ restrictions and requirements.

The benefitis administered by scores of companies under contract to Medicare. Eachplan has its own list of covered drugs, known as a formulary. Drugplans require doctors and patients to obtain “prior authorization” forcertain drugs on their formularies.

The procedures vary byplan. One plan may have 25 or 30 forms for prior authorization fordifferent drugs. Most states have at least 40 Medicare drug plans.

Doctors say the diverse requirements are onerous and can delay or denyaccess to needed medications. But insurers say the requirements savemoney and promote the proper use of the medications.

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