Drug Pricing Reform In Medicaid: Watch This Space
Some manufacturers may have to start essentially paying Medicaid programs to cover their drugs beginning in 2024 under a provision in the US economic relief bill headed to President Biden.
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Risk-averse decision-making climate at CMS and a likely unwillingness to commit the resources needed probably means that innovative payment arrangements for cell and gene therapies may have to start in the commercial insurance sector, Demetrios Kouzoukas suggests.
As MACPAC moves toward formal recommendations, a CBO analysis finds that differential Medicaid rebates for drugs approved through the accelerated pathway could save the federal government up to $1bn over five years.
There won’t be a lot of legislative action in Congress in the weeks following passage of the $1.9tn American Rescue Plan. But the coming months are a critical time for the drug industry to try to set the terms for how it is treated in the next major bill later this year, and the stakes could not be higher.