Document Type
Report
Publication Date
5-2014
Publisher
The Kaiser Family Foundation
Abstract
Since the early 2000s, state Medicaid programs have made concerted efforts to control the cost of prescription drug spending. One crucial aspect in doing so is using a pharmacy reimbursement methodology that best reflects actual drug costs. Currently, states set pharmacy reimbursement policy within broad federal guidelines, resulting in a complex mix of reimbursement rules. Many states use list prices to set reimbursement levels, and these list prices increasingly have been criticized as not accurately reflecting the cost of the drug. Specifically, there are concerns that some benchmarks lead to inflated reimbursement levels. As a result, the federal government has proposed new rules that aim to make reimbursement policies more closely match the cost of obtaining and filling prescriptions. However, the change in policy may have varying effects on reimbursement, depending on the state’s current approach and the type of drug in question. This paper explains current Medicaid pharmacy reimbursement methodology and examines the potential effect of the proposed rule changes.
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Recommended Citation
Bruen, Brian K. and Young, Katherine, "Paying for Prescribed Drugs in Medicaid: Current Policy and Upcoming Changes" (2014). Health Policy and Management Issue Briefs. Paper 55.
https://hsrc.himmelfarb.gwu.edu/sphhs_policy_briefs/55
Open Access
1
Included in
Health Law and Policy Commons, Health Policy Commons, Health Services Administration Commons
Comments
Reproduced with permission of the Kaiser Family Foundation.