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Medicaid ‘Price Verification’ Audit Proposal Aims To Promote Cell, Gene Therapy Rebate Concessions

 
• By Cathy Kelly

CMS proposed rule impact may be ‘modest’ but is framed as ensuring patient access to cutting edge treatments by helping to control Medicaid spending. Biden administration initiative also aims to address misclassification of brand drugs, duplicative 340B discounts, and PBM spread pricing.

CMS Hopes To Pressure Manufacturers With Threat Of Price Transparency • Source: Shutterstock

Manufacturers of up to 10 high-cost treatments including cell and gene therapies could be required to provide data to Medicaid on pricing, clinical benefit and the cost of production in an annual audit as part of an effort by the federal government to provide states with more tools to negotiate price concessions.

The Centers for Medicare and Medicaid Services described the audit policy in a proposed rule released on 23 May. The proposal also addresses several other policies related to the...

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