CMS Wants To Facilitate Value-Based Discounts For HCV Drugs In Medicaid
This article was originally published in The Pink Sheet Daily
CMS requests information from hepatitis C manufacturers on how value-based purchasing arrangements might work in Medicaid. Agency also urges state Medicaid directors to relax overly strict coverage requirements for the drugs.
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States are eager to try more aggressive methods to rein in prescription drug costs under Medicaid, and CMS is willing to be flexible in permitting innovative contracting. But the agency is also quietly but firmly making clear that all FDA-approved drugs have to be treated the same.
Trio Health data covering 15,000 patients over three years reveals that 29% of patients failed to start prescribed HCV treatment in 2016, up from 8% in 2104. The "non-starts" appear partially due to denials of coverage by payers and not even the sickest patients have been shielded.
The move to deny coverage for an approved orphan drug is ‘highly unusual,' NORD VP says. 'We certainly hope this isn’t going to set a precedent.'