Negative formulary change
Negative formulary change means one of the following changes with respect to a covered Part D drug: (1) Removing a drug from a formulary. (2) Moving a drug to a higher cost-sharing tier. (3) Adding or making more restrictive prior authorization (PA), step therapy (ST), or quantity limit (QL) requirements. Negative formulary changes do not include safety-based claim edits which are not submitted to CMS as part of the formulary.