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CMS To Issue Guidance Interpreting Affordable Care Act's Effect On Medicaid Formularies

This article was originally published in The Pink Sheet Daily

Executive Summary

Confusion has arisen as to whether the health reform statute's changes to Medicaid drug rebates means that a state Medicaid program's fee-for-service and managed care organization formularies must be identical.

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Medicaid MCOs Retain Formulary Flexibility Under Affordable Care Act

CMS clarifies that Medicaid drug rebate provisions under the Affordable Care Act should not be interpreted to mean that a state's Medicaid fee-for-service and managed care organizations must have the same formularies.

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