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CMS issued a proposed rule on June 17 aimed at making it easier for state Medicaid programs to enter into outcomes-based contracts with drug manufacturers. Among other policy revisions, the rule would allow manufacturers to report multiple “best prices” for a therapy under the Medicaid Drug Rebate Program if the prices are tied to a value-based payment arrangement. CMS Administrator Seema Verma touted the proposed rule as a way to lower prescription drug costs in general. “CMS’s rules for ensuring that Medicaid receives the lowest price available for prescription drugs have not been updated in thirty years and are blocking the opportunity for markets to create innovative payment models. By modernizing our rules, we are creating opportunities for drug manufacturers to have skin in the game through payment arrangement[s] that challenge them to put their money where their mouth is,” she said in a statement about the new proposal. Read the proposed rule at

Despite calls for expanded testing to detect coronavirus cases and ensure Americans can safely return to work, some private health insurers may cover only those deemed medically necessary, Reuters reported. Such policies could limit testing to people who either have symptoms of COVID-19 or have been in close contact with someone who has, the article pointed out. Meanwhile, states including Georgia, North Dakota, Oklahoma, Tennessee and Washington have taken steps to ensure patients are protected from being balance billed for coronavirus tests, such as capping costs or more narrowly defining what insurers should pay for, Politico reported. Read more at and

© 2021 MMIT

AIS Health Staff

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