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New Combo Products Exempt From Medicaid Rule Applying Price Inflation Rebates To Line Extensions

 
• By Cathy Kelly

CMS final rule narrows definition of new formulations potentially subject to much higher Medicaid rebates and delays effective date of provisions targeting health plan copay accumulator programs.

Policy Could Significantly Boost Manufacturer Rebates To Medicaid

New drug/drug and drug/device combination products will not be subject to price inflation rebates in the Medicaid program under a final rule published by the Centers for Medicare and Medicaid Services on 31 December.

The rule seeks to establish clear specifications for what constitutes a line extension that would be subject to Medicaid rebate requirements, including price inflation rebates, on par with the original drug. Other provisions in the rule address Medicaid price reporting changes that could facilitate value-based payment arrangements

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House Budget Bill Includes Delayed Orphan Fix, Also Risks Downstream Cell and Gene Coverage

 
• By Sarah Karlin-Smith

The first two classes of negotiated drugs under the Inflation Reduction Act would not benefit from a rare disease adjustment House Republicans included in their reconciliation package.

Most Favored Nation Pricing Policy Floated In Medicaid, Coming Back To Medicare?

 
• By Cathy Kelly

President Trump's ongoing interest in the policy, which would ensure the US government pays no more for prescription drugs than the lowest price available in comparable countries, continues to gain attention.

If CMS Takes Over 340B, Will Government Allow Rebate Model Changes?

 
• By Cathy Kelly

Manufacturers have supported the proposed shift in oversight authority, which could create a more pharma-friendly environment in the drug discount program, but uncertainty remains.

GLP-1 Drug Coverage Growing For Obesity In Medicaid, But Only For Diabetes In Medicare

 
• By Cathy Kelly

Coverage data from the two programs suggest Medicare beneficiaries may be more disappointed than Medicaid enrollees by the Trump Administration’s decision not to mandate the programs cover obesity drugs.

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