Drug Costs

Congress and the Biden Administration are currently pursuing substantial drug pricing reforms as part of the reconciliation legislation expected to move this fall.  While the focus is primarily on Medicare, Medicaid should not be overlooked. In an ongoing series of posts for the Commonwealth Fund’s To the Point blog, I examine some key Medicaid drug…

In a new groundbreaking study, the Congressional Budget Office compared brand-name drug prices, net of rebates and discounts, across select federal programs and agencies including Medicaid, Medicare Part D and the Department of Veterans Affairs (VA).  It found that Medicaid gets the lowest net prices, far below that of Medicare Part D plans and well…

On Monday, February 22, the House Budget Committee plans to mark up the House COVID-19 relief reconciliation bill, with the full House possibly voting on the bill later in the week.  As I have previously explained, one sound Medicaid provision — section 3107 of the bill —would, as of January 1, 2023, eliminate the current…

Last night, the House Energy and Commerce Committee unveiled its recommendations for the House COVID-19 relief reconciliation bill, with a markup scheduled for February 11, 2021.  One sound Medicaid provision would, as of January 1, 2023, eliminate the current cap on total drug rebates that manufacturers must pay state Medicaid programs, which would produce significant…

CCF has submitted public comments to the Centers for Medicare and Medicaid Services (CMS) on the proposed Medicaid drug rebate rule which, among other things, would change how drug manufacturers report “best price” under the effective Medicaid Drug Rebate Program. As I have explained, the proposed rule’s best price reporting changes are intended to facilitate…

On September 29, the President signed into law a fiscal year 2020 appropriations bill (H.R. 4378) that temporarily funds the federal government through November 21.  The bill also includes several short-term extensions of critical health provisions that were scheduled to expire: full Medicaid funding for Puerto Rico and the other territories, a delay in scheduled…

Editor’s Note: The Senate Finance Committee reported the bill on July 25, 2019 (without substantive changes to its Medicaid provisions.) On Thursday, July 25, the Senate Finance Committee is scheduled to consider bipartisan drug pricing legislation (known as the Prescription Drug Pricing Reduction Act).  While much of the bill focuses on provisions related to Medicare…

On July 10, the Trump Administration announced that it would withdraw a proposed rule to eliminate the safe harbor in the federal anti-kickback law for rebates negotiated by pharmacy benefit managers (PBMs) on behalf of Medicaid managed care plans and Medicare Part D plans.  This is a highly welcome move.  As we have explained since…

As I have previously warned, the ongoing prescription drug pricing debate could intentionally or unintentionally lead to significant harm to the Medicaid program and its effective Drug Rebate Program.  That, in turn, could result in higher federal and state Medicaid drug costs and reduced beneficiary access to needed medications. One key element of the Medicaid…

We submitted comments to the Trump Administration’s proposed regulation to eliminate the safe harbor in the federal anti-kickback law for rebates negotiated by pharmacy benefit managers (PBMs) on behalf of Medicaid managed care plans (and Medicare Part D plans).   As we have previously written, the proposed regulation raises serious concerns because it would likely…

As federal efforts to address prescription drug costs intensifies, this three-part blog series addresses misleading claims or confusion about Medicaid, its highly effective drug rebate program and overall drug pricing issues in the hopes of better informing the debate moving forward. Part I | Part II Medicaid’s best price requirement is not the reason why…