Massachusetts Wants To Drive Down Medicaid Drug Costs: Why Is The Administration So Nervous? image

Health Affairs, April 5, 2018
Nicholas Bagley, and Rachel Sachs (Academic Fellow Alumna)

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From the article:

Although drug formularies are ubiquitous in Medicare and the private insurance market, they’re absent in Medicaid. By law, state Medicaid programs that offer prescription drug coverage (as they all do) must cover all drugs approved by the U.S. Food and Drug Administration, however expensive they are and however slim their clinical benefits may be.

Massachusetts would like to change all that. In a recent waiver proposal, Massachusetts asked the Centers for Medicare and Medicaid Services (CMS) to allow it to adopt a closed formulary in Medicaid. That would allow Massachusetts to exclude certain brand-name drugs from Medicaid, increasing its leverage in price negotiations beyond what it can achieve through existing utilization management techniques like prior authorization.

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health care finance health care reform medicaremedicaid pharmaceuticals rachel sachs