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Tennessee Medicaid Gets US Approval For Closed Formulary As Part Of ‘Capped’ Spending Program

 
• By Cathy Kelly

Demonstration, which may not survive scrutiny from the Biden Administration, includes some protections, such as prohibiting Tennessee from excluding drugs described in the Medicare Part D protected classes policy.

Tennessee Medicaid Is First To Adopt Capped Federal Funding Approach

Tennessee’s Medicaid program has obtained federal government approval to adopt a closed formulary to increase its leverage in manufacturer negotiations and lower prices, even while it continues to collect mandatory rebates from manufacturers.

The Centers for Medicare and Medicaid Services approved the formulary flexibility using its waiver authority under section 1115 of the...

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