On June 27, the Centers for Medicare and Medicaid Services partially approved Massachusetts’ Medicaid waiver proposal, but among other provisions, rejected a proposal to impose a “closed formulary” for prescription drugs under which the state could entirely exclude coverage of certain drugs in ways not permitted under current law. Instead, CMS expressed openness to approving […]
MedPage Today By: Joyce Frieden The federal government will stop making risk adjustment payments to health insurers that have sicker-than-average patients, raising the specter of more premium increases by insurers to make up for the shortfall. … Withholding the payments will have both short-term and long-term effects, according to Edwin Park, JD, of Georgetown University. […]
Modern Healthcare By: Virgil Dickson The CMS has denied Massachusetts’ request to become the first state in the nation to determine which drugs it will cover in its Medicaid program. … If states do pursue the demo the CMS described, access to drugs could be harmed as it’s unlikely states will get discounts as deep as […]
In May, the Trump Administration unveiled its drug pricing blueprint and is now seeking public comments. We would like to share our submitted comments to the blueprint, which focus on Medicaid, and encourage you to submit your own comments by the July 16 deadline. Prescription drugs are essential for the health of tens of millions […]
A recent report from the HHS Office of Inspector General found that Medicare Part D spending on brand-name drugs, net of rebates, increased by 62 percent between 2011 and 2015. For nearly half of all brand-name drugs reimbursed by Part D, unit costs increased by at least 50 percent and for 12 percent of such […]
Last week, I wrote about how data from the recent Medicare Trustees report show the highly effective Medicaid drug rebate program continues to produce substantially larger rebates from drug manufacturers than private insurers in Medicare Part D do. Now, new preliminary data from an analysis conducted by the Congressional Budget Office similarly finds that Medicaid […]
