Medicaid ‘Price Verification’ Audit Proposal Aims To Promote Cell, Gene Therapy Rebate Concessions
CMS proposed rule impact may be ‘modest’ but is framed as ensuring patient access to cutting edge treatments by helping to control Medicaid spending. Biden administration initiative also aims to address misclassification of brand drugs, duplicative 340B discounts, and PBM spread pricing.
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The US Medicaid program is proposing what amounts to a price negotiation program by using a survey/audit authority as a 'stick' to encourage manufacturers to offer supplemental rebates or outcomes-based contracts. Is it an offer sponsors can’t refuse?
The demonstration project planned by the US Centers for Medicare and Medicaid Services is in keeping with past agency efforts to promote value-based contracts for cell and gene therapy.
Agency cites possible demonstration in response to HHS Office of Inspector General report urging reimbursement reforms to spur greater use of biosimilars and lower costs for Medicare and beneficiaries.