Medicare Formulary Updates Impact

ACPE UAN #:  0233-0000-19-026-H04-P

Release Date:  March 26, 2019

Expiration Date:   March 26, 2022

Activity Type:    Knowledge-based

Contact Hours:  1.25 contact hours

Activity Fee:  Member:  $15        Non-Member: $30

Target Audience: Pharmacists who practice in managed care settings.

Activity overview

The Centers for Medicare and Medicaid (CMS) continues to critically evaluate formulary regulations and guidance to help lower drug costs. This session will inform health plans, pharmacy benefit managers (PBMs) and other health care professionals about the CMS changes to Medicare Part D that will be implemented in 2019 and 2020, and their operational and financial implications. Changes that will be covered include allowing health plans and PBMs to utilize step therapy for Part B drugs while integrating with care coordination programs; the allowance of indication-based formularies; and substituting generics for brands as soon as they are available without CMS prior approval. Faculty will also review other new changes from the CMS 2020 Call Letter that will impact the health care community.

Learning Objectives:

At the completion of this activity, participants should be able to:

  1. Identify the Centers for Medicare and Medicaid (CMS) regulations and guidance that impact formulary management for 2020.
  2. Define the rules for Part B step therapy and the drug classes most likely impacted.
  3. Describe indication-based formularies and their implementation in Part D.
  4. Discuss how the new CMS formulary guidance can potentially impact star ratings, operations, and CMS audits.

Schedule of Educational Activity

This activity consists of an audio recording, pre-test assessment questions (not required to pass or continue), post-test questions (required to pass with a score of 70% or higher) and a specific activity evaluation. 

CPE Requirements:   

Participants should claim continuing pharmacy education (CPE) credit for this home study activity only if they have not claimed credit for the live activity presented at AMCP Annual Meeting 2019.

CPE credit will be processed through the AMCP Learn portal and reported directly to CPE Monitor.  Please allow 72 hours for processing and posting in your NABP account.

To receive credit for an online activity you must:

  • Review the full content of the activity.
  • Successfully complete the post-test (required to pass with a score of 70% or higher, it may be taken a maximum of three times).
  • Complete a specific activity evaluation.

System Technical Requirements/Viewing Requirements: System Requirements Courses and learning activities are delivered via your Web browser and Acrobat PDF. For all activities, you should have a basic comfort level using a computer and navigating web sites.  View the minimum technical and system requirements for continuing education online learning activities.

As an accredited provider, AMCP strictly adheres to the ACPE Standards for Commercial Support and other relevant guidelines and standards to ensure the independence of continuing pharmacy education (CPE) activities.  It is AMCP’s intent that all CPE activities be independent, objective, balanced, evidence-based and free of any commercial bias.


Jenny Glennon, PharmD, MPH | Director, Pharmacy Services | Health Dialog |Bedford, New Hampshire 

Credit Information

Activity Number Credit Amount Accreditation Period
ACPE UAN #0233-0000-19-026-H04-P 1.25 Contact Hours March 26, 2019 - March 26, 2022