Medicare Model Guidelines v5.0 & v4.0

The Medicare Modernization Act designates USP to develop the Model Guidelines and "to revise such classification from time to time to reflect changes in therapeutic uses of covered part D drugs and additions of new covered part D drugs." The links below provide access to v5.0 and v4.0 of the Guidelines (in PDF and Excel formats) along with information about USP's approach to the revision process.

USP Model Guidelines Version 5.0

Applicable to formularies designed for the 2012 through 2014 benefit years:

• USP Model Guidelines v5.0 (Categories and Classes)—PDF
• USP Model Guidelines v5.0 (Categories and Classes)—Excel
• USP Model Guidelines v5.0 (With Example Drugs)—PDF
• USP Model Guidelines v5.0 (With Example Drugs)—Excel
• USP Model Guidelines v5.0 (Showing changes from v4.0)—PDF
• USP Model Guidelines—CMS Formulary Reference File (FRF) Alignment—Excel
• Final Report and Summary of Methodology and Approach (including commentary)—PDF

USP Model Guidelines Version 4.0

Applicable to formularies designed for the 2009 through 2011 benefit years:

• USP Model Guidelines and Formulary Key Drug Types Version 4.0—PDF
• USP Model Guidelines and Formulary Key Drug Types Version 4.0—Excel
• Summary of Approach and Methodology—PDF
• USP Model Guidelines Version 4.0 Commentary—PDF