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 […]
On Wednesday, April 26, 2023, the Health Subcommittee of the House Energy and Commerce Committee will hold a legislative hearing discussing numerous health bills including H.R. 2666 — the “Medicaid VBPs for Patients Act.” This bill would codify for five years a technical rule finalized late in the Trump Administration that, among other provisions, allowed […]
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, […]
