CMS Proposes Best Price Waivers for Costly New Therapies

In an effort to boost adoption and lower costs for curative therapies, CMS proposed a new rule that the agency says would allow state Medicaid plans to enter into value-based, outcome-dependent purchasing agreements with drug manufacturers using a new interpretation of best price rules. The new rule also criticized insurers’ redirection of copay accumulators, a common arrangement between plans and patients to pay for expensive specialty drugs.

CMS proposed an updated interpretation of Medicaid “best price” rules — which dictate how rebates are calculated in the Medicaid Drug Rebate Program — by clarifying best price reporting requirements and enabling new structures including year-to-year scheduled prices that could change in relation to patient outcomes. CMS Administrator Seema Verma positioned the new regulation as part of the Trump administration’s broader efforts to lower drug prices and argued that the rule will speed adoption of expensive curative therapies.

© 2023 MMIT
Peter Johnson

Peter Johnson

Peter has been a reporter for nearly a decade. Before joining AIS Health, Peter covered a wide variety of topics in his hometown of Seattle, where he continues to live. Peter’s work has appeared in publications including The Atlantic and The Stranger. Peter attended Colby College.

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