Drug Costs

CBO Confirms House Bill Prohibiting Use of “QALYs” Would Undermine State Negotiation of Medicaid Supplemental Rebates

I previously raised significant concerns about a House health bill that would expand an existing Medicare prohibition on the use of Quality-Adjusted Life Years (QALYs) to other federal programs including Medicaid and the Children’s Health Insurance Program (CHIP).  I warned that the bill was overbroad in its prohibition of the use of QALYs and could […]

New Inspector General Report Finds Manufacturers Would Have to Pay Substantial Rebates if the Medicaid Drug Rebate Program Applied to Separate State CHIP Programs

The Office of Inspector General (OIG) at the Department of Health and Human Services issued a new report estimating that applying the Medicaid Drug Rebate Program (MDRP) to separate state CHIP programs would have resulted in drug manufacturers paying $641.2 million in rebates in calendar year 2020 alone, with the federal government receiving $515.7 million […]

New CMS Proposed Rule Could Help State Medicaid Programs Negotiate Greater Supplemental Rebates for Certain High-Cost Drugs

On May 23, 2023, the Centers for Medicare and Medicaid Services announced a new proposed rule related to the Medicaid Drug Rebate Program (MDRP) and other Medicaid drug pricing, reimbursement and data collection issues. While much of the proposed rule focuses on regulatory changes conforming to legislation affecting the MDRP enacted in recent years as […]