On Drug Prices, Trump Administration Sends Mixed Messages
"
Other states have already reached out to
"[Pharmaceutical companies] have done some similar things in the commercial space and wondered why they can't do that with us," she says.
While most private insurance plans can and will refuse to cover drugs when there is a cheaper or generic alternative, state Medicaid programs are required to cover every drug approved by the
The
States already receive a discount for prescriptions -- sometimes up to 50 percent -- through the Medicaid Drug Rebate Program, but Nesser says it's not enough. Prescription drugs cost Medicaid programs
If CMS had approved
In its rejection, CMS said that
"Some of the smaller companies have really been open to it, and some of the bigger companies haven't," Nesser says. "That really has surprised me. I figured it'd be the other way around."
It's up to the state to decide if drugs are working as intended -- a process Nesser says will be labor-intensive. The state will primarily use refill data to track outcomes. If people aren't refilling a certain prescription, the state can assume it's not working correctly.
"One thing we've learned is that some companies don't really stand behind their drugs, and it's kind of scary. ... We're paying a premium for them, and they're not willing to say that they will work," Nesser told the
There is some skepticism among health experts about how much money
"Will this be a watershed program? I don't think so. But I also don't want to downplay it because this is the first time we'll see true outcomes-based pricing in the Medicaid program," says Margulies. "It is a clever way to get around best-price rules."
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