Medicare Compliance & Reimbursement

Plans can cover prescription niacin, feds allow.

Medicare beneficiaries with high cholesterol now have a fighting chance of coverage for a prescription drug they may need.

Physicians often prescribe the vitamin niacin to fight high cholesterol. But Medicare Part D's prescription drug plans nixed coverage for prescription niacin because the program by law disallows coverage for "prescription vitamins."

In an April 11 memo to drug plans, the Centers for Medicare & Medicaid Services said plans can include the prescription niacin products Niaspan and Niacor on Part D formularies.

That move comes in spite of a CMS policy clarification it issued in February after some plans had included the drugs on their formularies amid confusion over the medication. The February policy clarification directed plans to end the coverage by May 31, stating that Medicare would not pay for the products as Part D law excludes coverage of prescription vitamins.

The agency corrects itself in the April memo, saying that on closer review of the policy, they have determined that Niaspan and Niacor should not be counted as vitamins and therefore are not "universally excluded." Niaspan and Niacor have FDA approval, are used therapeutically for a specific condition, are not used as nutritional supplements or to address a vitamin deficiency, and are used at much higher dosages than for supplemental use.

Niacin is also available as a supplement, but the American Heart Association maintains the supplement form should not be used to lower cholesterol because of potentially serious side effects.

Plans now have the option of adding the drugs to their formularies for this year and 2007.