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PharmacoEconomics & Outcomes News 533 - 28 Jul 2007 Regulation set to reduce Medicaid reimbursements The US government has issued a new regulation which will alter the method of setting limits for the reimbursement of prescription drug payments to state Medicaid agencies by the federal government. This regulation is expected to save state and federal governments $US8.4 billion over the fiscal years 2007 to 2011. The Medicaid programme will still spend an expected $US140 billion on drugs over the same period. As part of the 2005 Deficit Reduction Act (DRA), this change is a response to both the Government Accountability Office and the HHS Office of the Inspector General’s reports, which revealed that Medicaid payments to pharmacies for generic medicines were significantly greater than what those pharmacies were actually paying for such drugs. The DRA has also introduced transparency into the process of Medicaid prescription drug pricing by requiring that, for the first time, Average Manufacturers Prices (AMPs) for drugs be publicly reported on the Internet. Manufacturers will now be required to report AMPs monthly, as well as quarterly; this information will be used as the basis for determining state drug reimbursement prices. Centers for Medicare and Medicaid Services. New Medicaid Drug Payment Rule. Media Release : 6 Jul 2007. Available from: URL: http:// www.cms.hhs.gov 809078117 1 PharmacoEconomics & Outcomes News 28 Jul 2007 No. 533 1173-5503/10/0533-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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Page 1: Regulation set to reduce Medicaid reimbursements

PharmacoEconomics & Outcomes News 533 - 28 Jul 2007

Regulation set to reduce Medicaidreimbursements

The US government has issued a new regulationwhich will alter the method of setting limits for thereimbursement of prescription drug payments to stateMedicaid agencies by the federal government.

This regulation is expected to save state and federalgovernments $US8.4 billion over the fiscal years 2007 to2011. The Medicaid programme will still spend anexpected $US140 billion on drugs over the same period.

As part of the 2005 Deficit Reduction Act (DRA), thischange is a response to both the GovernmentAccountability Office and the HHS Office of theInspector General’s reports, which revealed thatMedicaid payments to pharmacies for genericmedicines were significantly greater than what thosepharmacies were actually paying for such drugs.

The DRA has also introduced transparency into theprocess of Medicaid prescription drug pricing byrequiring that, for the first time, Average ManufacturersPrices (AMPs) for drugs be publicly reported on theInternet. Manufacturers will now be required to reportAMPs monthly, as well as quarterly; this information willbe used as the basis for determining state drugreimbursement prices.Centers for Medicare and Medicaid Services. New Medicaid Drug Payment Rule.Media Release : 6 Jul 2007. Available from: URL: http://www.cms.hhs.gov 809078117

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PharmacoEconomics & Outcomes News 28 Jul 2007 No. 5331173-5503/10/0533-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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