One important, but less-noticed, provision in the Medicare program exempts Medicare drug plans from the "best price" policy that limits the ability of health plans and PBMs to negotiate low drug prices. Now the Bush administration is looking to drop the best price requirement for all drug purchasers.
Washington, D.C. - One important, but less-noticed, provision in the Medicare program exempts Medicare drug plans from the "best price" policy that limits the ability of health plans and PBMs to negotiate low drug prices. Now the Bush administration is looking to drop the best price requirement for all drug purchasers.
Congress added "best price" to Medicaid a decade ago to encourage pharmaceutical marketers to give Medicaid their very lowest prices. Manufacturers agreed to pay rebates to state Medicaid programs of about 15% in return for a limit on offering even lower discounts to other customers. The feds subsequently provided an exemption from best price for drugs purchased by the Veterans Administration and other government agencies, including the new Medicare program. But HMOs and hospitals have complained for years that best price prevents them from negotiating low prices for their formularies. CMS administrator Dr. Mark McClellan evidently agrees and has proposed switching to a flat rebate formula for everyone. The aim is not to curb Medicaid prescription drug spending, but to help reduce costs for the broader healthcare system.
-Jill Wechsler
In this latest episode of Tuning In to the C-Suite podcast, Briana Contreras, an editor with MHE had the pleasure of meeting Loren McCaghy, director of consulting, health and consumer engagement and product insight at Accenture, to discuss the organization's latest report on U.S. consumers switching healthcare providers and insurance payers.
Listen
Price Transparency Reveals Multiple Dimensions of Healthcare Inequities Beyond Just Patients
October 23rd 2024Pricing data shows that doctors serving these communities facing economic challenges are paid less by insurers, effectively penalizing doctors for working in areas where people most need their care.
Read More
In our latest "Meet the Board" podcast episode, Managed Healthcare Executive Editors caught up with editorial advisory board member, Eric Hunter, CEO of CareOregon, to discuss a number of topics, one including the merger that never closed with SCAN Health Plan due to local opposition from Oregonians.
Listen