please wait, site is loading

Blog

Medicaid Pharmacy Supplemental Rebate Agreements (Sra)

Opublikowano: grudzień 12th, 2020 by foto-klinika |

In addition to rebates negotiated with pharmaceutical manufacturers, Member States can also save money by regulating the way rebates are treated with PBM. While the regulation of PBMs is not unusual, only three states – Arkansas, Louisiana and New York – have imposed rules on PbM that go beyond the exchange of discount information.93 As expected, each bill from that state prohibits spread prices, which occurs when a PBM reimburses a pharmacy for less than the amount charged to the health plan. , and the difference.94 In other words. , these states prohibit PBMs from marking the price of prescription drugs charged at all levels. This report examines the policy options available to states and Washington, D.C. to reduce their drug spending. First, two options are being considered for public Medicaid programs: negotiating additional rebates and improving verification of drug use. The report then examines reforms to improve a state`s bargaining power, including consolidating procurement through state programs or with other states; Creating a common formula beyond government programs; Consolidation of service purchases provided by the Pharmacy Services Manager (PBM); Negotiate discounts with PBM and the implementation of the subscription-based purchase. Finally, this report examines reforms to reduce the list prices of prescription drugs, including the creation of a body to verify the affordability of prescription drugs; Reference drugs for the price; Maximize participation in the 340B Drug Pricing Program; Encourage the use of generic drugs Reduce the cost of medications administered by a doctor and the importation of drugs from Canada. While not specifically focused on Medicaid or MDRP, policy proposals to change the structure of rebates or prices in Medicare and the private market have an impact on Medicaid. These indirect effects occur because many proposals influence list prices or EDP, which affects the calculation of the Medicaid rebate. In early 2019, for example, the Trump administration released a proposed rule that would exclude payment by drug manufacturers to PBMs, Medicare Part D-Plans sponsors and Medicaid Managed Care Organization (MCO) of “safe harbor” protection measures that would have exempted these payments from anti-kickback penalties. The administration withdrew the idea, but analyses of the proposal showed at the time that it would increase Medicaid`s spending.

This result would result from lower manufacturers` list prices, which would reduce the inflationary Medicaid rebate.63 Similarly, proposals (such as the administration64 and House Democrats) to bring Medicare drug prices more in line with drug prices in other countries could have an impact on Medicaid rebates and, ultimately, on Medicaid drug spending by changing drug prices. Policy changes that would allow the federal government to negotiate Medicare prices may also affect Medicaid, depending on how the price applies to the broader market and the prices used to set Medicaid rebates65. In California, CalPERS plans to launch a reference price pilot program starting in 2020 that will apply to limited classes of prescription drugs: inhaled corticosteroids, Thyroid and oral estrogens.116 To determine who would be the right candidates, CalPERS and its pharmacy provider, the University of Massachusetts Medical School of Clinical Pharmacy Services, focused on patient safety and the needs of the population taking the drug.