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 […]
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, […]
Editor’s Note: An amended version of the bill (H.R. 485) was reported by the Subcommittee on Health of the House Energy and Commerce Committee on March 8, 2023. The revised language addresses some of the concerns discussed in this blog post. A House bill (H.R. 485) which was one of the bills discussed at a […]
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 […]
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 […]
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 […]
