The changes would allow commercial health insurers to enter into “value-based” payment schemes, the Centers for Medicare & Medicaid Services say.
Reuters:
‘Medicaid Best Price’ Changes Aimed At Value-Based Gene Therapy Contracts: U.S. Agency
Proposed changes to requirements that state-run Medicaid programs are given the best drug prices would clear the way for commercial health insurers to enter into “value-based” payment schemes, the U.S. Centers for Medicare & Medicaid Services said on Wednesday. Drug manufacturers by law must give Medicaid their “best price,” meaning the lowest price they negotiate with any other buyer. But health plans have expressed concerns that the requirement prevents them from linking drug prices to patient outcomes – a practice known as “value-based” pricing. (Beasley, 6/17)
Modern Healthcare:
CMS Proposed Rule Aims To Encourage Value-Based Drug Pricing
The CMS wants to make it easier for private insurers, state Medicaid programs and prescription drug manufacturers to strike up value-based payment arrangements tied to clinical outcomes. The agency issued a proposed rule late Wednesday designed to overhaul regulations that hinder such payment arrangements, with the goal of expanding access to new, high-cost drugs, such as gene therapies. (Livingston, 6/17)
Stat:
New Trump Proposal Seeks To Encourage ‘Value-Based’ Drug Pricing Deals
The Trump administration wants to revamp certain Medicaid rules about drug prices in hopes of encouraging major insurers and pharmaceutical companies to make better deals for pricey drugs. The proposal is an arcane Medicaid tweak, but it’s meant to open up a way to lower drug costs for far more Americans than just those in the federal insurance program. Drug makers have long complained that certain Medicaid rules get in the way of so-called value-based pricing arrangements, where insurers pay for drugs only when they work. (Florko, 6/17)
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