CMS Releases Proposed Rule on Medicaid Drug Value-based Purchasing Arrangements

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CMS Releases Proposed Rule on Medicaid Drug Value-based Purchasing Arrangements


The Centers for Medicare & Medicaid Services (CMS) June 17 released a proposed rule that would grant states greater flexibility in developing value based purchasing arrangements with drug manufacturers and health plans within the context of the Medicaid Drug Rebate program. In addition, the rule proposes revisions to how drug manufacturers should calculate average manufacturer price (AMP) of brand name drugs and an approach to promoting safer prescribing of opioids and other medications, as required by legislation.

The AHA will continue its review of the proposed rule and submit comments. Comments are due to CMS by July 20.

Highlights of the proposed rule follow under key resources.

Key Takeaways

The proposed rule would:

  • Provide states, drug manufacturers and health plans with flexibility to develop value-based purchasing arrangements.
  • Require health plans to count drug manufacturers’ financial assistance programs in consumers’ deductibles.
  • Provide guidance to state Medicaid programs and drug manufacturers on how to determine drug manufacturers’ financial assistance programs when calculating best practices and AMP.
  • Implement congressional actions regarding how generic drugs are counted in a brand name drug’s AMP and standards for state drug utilization review programs.

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