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.

© 2021 MMIT

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.

Related Posts

https://www.mmitnetwork.com/wp-content/uploads/2021/09/WordPress-Featured-Image-radar-on-drug-benefits-Experts-EU-Will-Continue-to-Beat-US-on-Biosimilar-Adoption.jpg
September 23

Experts: EU Will Continue to Beat US on Biosimilar Adoption

Read More
https://www.mmitnetwork.com/wp-content/uploads/2021/09/WordPress-Featured-Image-radar-on-drug-benefits-Pharma-Industry-Braces-as-Dems-Hash-Out-Drug-Price-Package.jpg
September 23

Pharma Industry Braces as Dems Hash Out Drug Price Package

Read More
https://www.mmitnetwork.com/wp-content/uploads/2021/09/WordPress-Featured-Image-radar-on-drug-benefits-Study-Flags-Potential-Benefit-of-Targeted-Medication-Reviews.jpg
September 23

Study Flags Potential Benefit of Targeted Medication Reviews

Read More

GAIN THERAPEUTIC AREA-SPECIFIC INTEL TO DRIVE ACCESS FOR YOUR BRAND

Sign up for publications to get unmatched business intelligence delivered to your inbox.

subscribe today