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It also provides access to Medicaid enrollment for low-income Marylanders. Enrollment started on October 1, 2013. [1] As of the 2019 calendar year, 156,963 people were enrolled in private health plans, 39,720 people were enrolled in stand-alone dental plans, and 1,076,175 people were enrolled in Medicaid through Maryland Health Connection. [2]
The AHFS DI is one of several compendiums [1] approved by the Social Security Act (Section 1861(t)(2)(B)(ii)(I)) as a source of off-label anti-cancer drug use. [2] [3] It was originally published in 1959 as the American Hospital Formulary Service (AHFS) by the American Society of Health-System Pharmacists.
Pharmacy and Therapeutics (P&T) is a committee at a hospital or a health insurance plan that decides which drugs will appear on that entity's drug formulary.The committee usually consists of healthcare providers involved in prescribing, dispensing, and administering medications, as well as administrators who evaluate medication use. [1]
[1] [2] Dual-eligibles make up 14% of Medicaid enrollment, yet they are responsible for approximately 36% of Medicaid expenditures. [3] Similarly, duals total 20% of Medicare enrollment, and spend 31% of Medicare dollars. [4] Dual-eligibles are often in poorer health and require more care compared with other Medicare and Medicaid beneficiaries. [5]
In the past, Congress authorized the Secretary of HHS to request USP to develop a drug classification system that Medicare Prescription Drug Benefit plans may use to develop their formularies, [6] and to revise such classification from time to time to reflect changes in therapeutic uses covered by Part D drugs and the addition of new covered Part D drugs.
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Centers for Medicare and Medicaid Services: CNA: Certified Nursing Assistant: COG: Children's Oncology Group: COTA(A) Council on the Ageing (Australia) CPhT: Certified pharmacy technician CPM: Certified Professional Midwife: CPME: Standing Committee of European Doctors: CRD: Centre for Reviews and Dissemination: CRN: Certified radiology nurse: CRNA
Starting in fiscal year 2024, 50 drugs with the same criteria as before would need to have their price negotiated. Any newly approved, single-source, brand name drugs that exceeds a price threshold that the HHS has set that was determined to likely to meet the spending criteria. The negotiated drug prices would have to meet the following criteria: