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CMS Changes The Dictionary: Medicaid ‘Best Price’ Could Soon Mean Many Things

 
• By Sarah Karlin-Smith

Value and outcomes-based purchasing agreements could see a boost under proposed Medicaid rule that CMS says will make it easier for manufacturers to experiment different contracting structures in the commercial health insurance market. CMS says the intent of these agreements is to lower drug prices for commercial payers, but the government acknowledges this is not guaranteed, and health policy experts worry both private payers and Medicaid could end up paying higher prices if the proposal is finalized.

best price concept 3d illustration isolated on white background
New Medicaid proposed rule would change best price reporting to accommodate value-based purchasing deals • Source: Shutterstock

Drug manufacturers will get a long-desired change to Medicaid best price reporting requirements under a new Centers for Medicare and Medicaid Services proposed rule that is designed to make it easier for manufacturers to enter into value-based drug pricing contracts with commercial payers, with the US government arguing the rule will be particularly useful for one-time use gene therapies with high upfront costs.

CMS says the change might lead to lower drug prices in the private sector while preserving Medicaid’s ability to get the best price on the US market, but many experts say that both of these claims are unlikely to be

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