Prescription Drugs

Issuers cannot use or implement any benefit designs that have the effect of discriminating against individuals on the basis of age, expected length of life, present or predicted disability, quality of life, or other health conditions. CMS uses the data collected in this portion of the QHP Application to review compliance for non-discrimination standards.

Application Resources
  • Instructions
    • PY2024 QHP Issuer Application Instructions: Prescription Drugs (Coming soon!)

  • Template
    • PY2024 Prescription Drug Template (Coming soon!)

  • Justifications/Supporting Documents
    • PY2024 Combined Prescription Drug Supporting Documentation and Justification for the following formulary reviews: Clinical Appropriateness Review, Formulary Outlier, Category/Class Benchmark Count (Coming soon!)
    • PY2024 Discrimination—Treatment Protocol Supporting Documentation and Justification (Coming soon!)

  • Frequently Asked Questions
  • Instructional Video