Medicaid’s Multiple Best Price Proposal Needs More Clarity Before Advancing, PhRMA Argues
Medicaid should go back to the drawing board on a key part of its proposal aimed at circumventing best price reporting obstacles to value-based purchasing.
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With gene therapies for sickle cell disease looming and two new expensive therapies of to a slow start, access challenges could prevent a large portion of patients from receiving treatment, a report from the US National Academies of Sciences, Engineering and Medicine concludes. The report urges development of new payment models, offering five ideas.
NASEM is expected to issue a highly anticipated report in early 2021 on solutions to address Rx vial drug wastage.
Value and outcomes-based purchasing agreements could see a boost under proposed Medicaid rule that CMS says will make it easier for manufacturers to experiment different contracting structures in the commercial health insurance market. CMS says the intent of these agreements is to lower drug prices for commercial payers, but the government acknowledges this is not guaranteed, and health policy experts worry both private payers and Medicaid could end up paying higher prices if the proposal is finalized.