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 […]
A bipartisan health price transparency bill — The Lower Costs, More Transparency Act (H.R. 5378) — is scheduled to be considered on the House floor “on suspension” this week. The bill includes two sound Medicaid provisions related to “spread pricing” in Medicaid managed care and to Medicaid pharmacy reimbursement, which are similar to those included […]
This year, there has been renewed focus in Congress on how to address the ongoing problem of drug shortages, especially with cancer patients now facing severe shortages of widely used generic chemotherapy drugs. On July 28, 2023, House Energy and Commerce Committee Chair Cathy McMorris Rodgers unveiled a draft bill intended to address the “root […]
On July 26, 2023, on a 26-1 bipartisan vote, the Senate Finance Committee approved the Modernizing and Ensuring PBM Accountability Act. The bill includes a number of Medicare provisions related to pharmacy benefit managers (PBMs) and pharmacies but also includes two sound Medicaid provisions related to “spread pricing” in Medicaid managed care and to Medicaid […]
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 […]
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 […]
