Drug Costs

Medicaid Drug Rebate Program News and Notes

As part of its fiscal year 2024 budget, the Biden Administration proposed several Medicaid and CHIP policies related to the Medicaid Drug Rebate Program, which I covered in a recent blog.  But over the last few months, there have been two other Medicaid drug rebate developments that are worth highlighting: Puerto Rico joins the Medicaid […]

Medicaid and CHIP Drug Rebate Proposals in the Biden Administration’s Fiscal Year 2024 Budget

Under the highly effective Medicaid Drug Rebate Program (MDRP), drug manufacturers must provide substantial rebates to the federal government and states as a condition of having their drugs covered by Medicaid.  For brand-name drugs, the rebates apply to  both fee-for-service and Medicaid managed care and consist of two mandatory components.  First, under a basic rebate, […]

New MACPAC Data on the Highly Effective Medicaid Drug Rebate Program

As I have previously explained, under the highly effective Medicaid Drug Rebate Program, drug manufacturers must provide substantial rebates to the federal government and states as a condition of having their drugs covered by Medicaid.  The rebates apply to both fee-for-service and to managed care.  A groundbreaking 2021 Congressional Budget Office study found that compared […]

Assessing the Potential Impact of the Inflation Reduction Act on Federal and State Medicaid Prescription Drug Spending

The Inflation Reduction Act (P.L. 117-169) did not include any drug pricing provisions directly affecting Medicaid.  But as I have previously written for the Commonwealth Fund, Medicare drug pricing reforms can interact with the highly effective Medicaid Drug Rebate Program, under which drug manufacturers must pay sizable rebates to state Medicaid programs that significantly lower […]

Congress Could Consider Medicaid and CHIP Drug Pricing Provisions

The Inflation Reduction Act (P.L. 117-169), signed into law on August 16, 2022, includes historic Medicare drug pricing provisions such as a requirement for Medicare to directly negotiate prices with drug manufacturers for certain high-cost drugs and a requirement that drug manufacturers pay rebates to Medicare if their prices rise faster than inflation. Unfortunately, the […]