rx2

It's time to change
Under the current Medicaid reimbursement rules, pharmaceutical companies
have an incentive to inflate private-sector prices so they can collect higher rebate
prices from a large Medicaid customer base. The CMS could revise its rules to
specify how manufacturers calculate best prices determined after the sale and
the patient’s recovery, as well as provide more guidance on how value-based contracts
and price reporting would affect other price regulations, the council said.
In the Medicare Part B program, many specialty drugs are reimbursed in physicians’
offices and hospital outpatient departments based on a 6 % markup
above the average sales price, which creates an incentive to raise costs.