Medicaid Demo’s Formularies Include Protections For HIV, Behavioral Health Drugs
Healthy Adult Opportunity initiative (don’t call it block grants) adopts some, but not all, of Medicare Part D’s protected classes, allowing states to exclude some drugs from coverage in the expansion Medicaid population to drive additional savings.
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The innovator biopharma industry understandably concerned about a Trump Administration proposal to allow states to implement restrictive formularies while still collecting mandatory rebates. But the formulary protections in the Trump plan are an important message about the likely shape of any future changes to the US market.
President Trump did not offer any new proposals on drug pricing during an evening featuring campaign theatrics on both sides.
CMS has abandoned its plan to give private plans more leverage in the “protected” drug classes in Part D. It will probably be a long time before anyone tries to change the protected classes again.