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CMS: Medicaid NPRM Aims to Foster VBP Models for Prescription Drugs

On June 17, the Centers for Medicare & Medicaid Services (CMS) released the "Establishing Minimum Standards in Medicaid State Drug Utilization Review (DUR) and Supporting Value-Based Purchasing (VBP) for Drugs Covered in Medicaid, Revising Medicaid Drug Rebate and Third Party Liability (TPL) Requirements (CMS 2482-P)."

The agency states that the proposals put forward support state flexibility to enter innovative value-based purchasing arrangements (VBPs) with drug manufacturers for new expensive therapies, and to provide manufacturers with regulatory flexibility to enter into VBPs with commercial payers, which will benefit Medicaid programs. The proposed rule also creates minimum standards in state Medicaid Drug Utilization Review (DUR) programs designed to reduce opioid-related fraud, misuse and abuse.

Read the CMS fact sheet on the proposed rule.  

Access the proposed rule. 

Read HealthAffairs blog by CMS Administrator Seema Verma.

Posted 6/17/2020