CMS issues proposed rule on value-based drug payment in Medicaid

The Centers for Medicare & Medicaid Services yesterday released a proposed rule revising requirements for value-based purchasing agreements between states and manufacturers for drugs covered by Medicaid.

According to CMS, the rule would change how manufacturers calculate average manufacturer price for brand name drugs with an authorized generic, and determine whether to include the value of their patient assistance programs when calculating “best price.” It also would revise definitions and reporting requirements for the Medicaid Drug Rebate Program; coordination of benefit and third-party liability rules for certain care and payment in Medicaid and the Children’s Health Insurance Program; and set minimum standards for state Medicaid Drug Utilization Review in an effort to reduce opioid-related fraud, misuse and abuse, among other changes.