Prescription Drugs Component of Medicaid Gaining Congressional Attention; Administration Already Moving on Topic

ANCOR is sharing this article by Politico Pulse as well as an item by MACPAC and Politico Pro as an update to this previous article, in case any of our members rely on the Medicaid rebate program.

As shared by Politico Pulse:

“Sens. Maggie Hassan and Bill Cassidy also are rolling out a bipartisan bill today to close a loophole in the Medicaid rebate program that they say pharmaceutical companies are using to make a bigger profit at the expense of patients, POLITICO’s Alice Miranda Ollstein scoops.

The Fair and Accurate Medicaid Pricing Act would direct pharma firms to leave the cost of generics out of the formula behind the Average Manufacturer Price, resulting in a higher payment to Medicaid programs.”

At the same time, in a press release for its June 2019 report, the Medicaid and Chip Payment Access Commission (MACPAC) issued recommendations to Congress on reducing the cost of prescription drugs in Medicaid.

As written by MACPAC:

“Washington, DC—The Medicaid and CHIP Payment and Access Commission (MACPAC) today called on Congress and the U.S. Department of Health and Human Services (HHS) to make changes to improve Medicaid policy affecting prescription drug and hospital payment, program integrity, and therapeutic foster care services for children and youth. The recommendations are part of MACPAC’s June 2019 Report to Congress on Medicaid and CHIP, one of two such reports that MACPAC is required by statute to publish annually. The June report to Congress also contains a congressionally requested analysis on Medicaid in Puerto Rico, which faces a funding shortfall early next year.

In Chapter 1 of the June report, the Commission makes the case for two statutory changes responding to state concerns about their ability to manage spending on outpatient prescription drugs, a sector expected to experience some of the largest growth in expenditures among health care goods and services over the next decade. MACPAC recommends enacting legislation that would provide states with a formal 180-day grace period similar to the current grace period under Medicare Part D and exchange plans. This would give Medicaid programs more time to establish appropriate coverage criteria and help prevent potential drug-related harm to patients.”

To provide a bird’s eye view of the topic, Politico Pro has shared that: “The administration’s final rule to eliminate rebates from Medicare Part D and Medicaid drug programs moved to the White House’s Office of Management and Budget for review [on June 11], the final step before the rule is published.”