Drug Rebate Equalization
MHPA Policy Statement on Medicaid Drug Rebates
MHPA applauds Congress for extending prescription drug rebates to states for Medicaid health plan enrollees through the Patient Protection and Affordable Care Act. This ends a long-time disparity in law that disadvantages states from receiving additional rebates for drugs simply because Medicaid beneficiaries are in Medicaid health plans. We believe this is a tremendous improvement in the administration of state Medicaid programs and will help improve care coordination and the quality of health care for Medicaid members.
Policy Activity
CMS's Initial Guidance on Implementing Medicaid Drug Rebate Increases and Equalization
On April 22nd, CMS issued a letter to State Medicaid Directors providing initial implementation guidance on the Medicaid Prescription Drug Rebate provisions in the Affordable Care Act. The letter provides information on the increased rebate percentages, the extension of the rebates to covered outpatient drugs dispensed to Medicaid MCO enrollees, and the rebate offsets.
The letter clarifies that any covered outpatient drug provided by MCOs are eligible for rebates; MCO capitation rates shall be based on actual cost experience related to rebates and subject to actuarial soundness rules; and what data MCOs must report to the state. CMS will be issuing further guidance on the drug rebates in the future. Click here to read the letter.
ACAP and MHPA Letter on Drug Rebate EqualizationHouse and Senate negotiators should add language in health reform legislation clarifying that health plans should have the ability to manage their own formularies, according to a letter sent on December 29, 2009 by MHPA and the Association for Community Affiliated Plans (ACAP). While the two trade associations representing Medicaid managed care plans expressed strong appreciation for including language extending rebates to pharmaceuticals provided to Medicaid managed care enrollees, they recommended a set of improvements to the language that would improve benefits for low-income Medicaid beneficiaries. Click here to read the letter.
Educational Resources
Visit the Resource Library for studies, reports and publications.
MHPA applauds Congress for extending prescription drug rebates to states for Medicaid health plan enrollees through the Patient Protection and Affordable Care Act. This ends a long-time disparity in law that disadvantages states from receiving additional rebates for drugs simply because Medicaid beneficiaries are in Medicaid health plans. We believe this is a tremendous improvement in the administration of state Medicaid programs and will help improve care coordination and the quality of health care for Medicaid members.
Policy Activity
CMS's Initial Guidance on Implementing Medicaid Drug Rebate Increases and Equalization
On April 22nd, CMS issued a letter to State Medicaid Directors providing initial implementation guidance on the Medicaid Prescription Drug Rebate provisions in the Affordable Care Act. The letter provides information on the increased rebate percentages, the extension of the rebates to covered outpatient drugs dispensed to Medicaid MCO enrollees, and the rebate offsets.
The letter clarifies that any covered outpatient drug provided by MCOs are eligible for rebates; MCO capitation rates shall be based on actual cost experience related to rebates and subject to actuarial soundness rules; and what data MCOs must report to the state. CMS will be issuing further guidance on the drug rebates in the future. Click here to read the letter.
ACAP and MHPA Letter on Drug Rebate EqualizationHouse and Senate negotiators should add language in health reform legislation clarifying that health plans should have the ability to manage their own formularies, according to a letter sent on December 29, 2009 by MHPA and the Association for Community Affiliated Plans (ACAP). While the two trade associations representing Medicaid managed care plans expressed strong appreciation for including language extending rebates to pharmaceuticals provided to Medicaid managed care enrollees, they recommended a set of improvements to the language that would improve benefits for low-income Medicaid beneficiaries. Click here to read the letter.
Educational Resources
Visit the Resource Library for studies, reports and publications.
Plan to Attend MHPA 2013
Save Oct. 20-22 for MHPA 2013 at the Gaylord National Resort & Convention Center at National Harbor, MD. Our annual conference again will be the country’s largest gathering of top-level executives in the Medicaid health plan industry. For sponsorship and exhibiting opportunities at MHPA 2013, please click here.
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