Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program Notice for Proposed Rulemaking (CMS-2434-P)

CMS’ recent rule, released on May 23, proposes to lower the cost of prescription drugs covered by Medicaid by increasing price transparency. The proposed regulation would give CMS and states additional tools, like a drug price verification survey, which would verify drug prices to increase transparency about why the costs of certain drugs are expensive for Medicaid and help states better negotiate what the Medicaid program pays for high-cost drugs. CMS also proposes that contracts between states, Medicaid-managed care plans, and third-party contractors, such as pharmacy benefit managers (PBMs), reflect transparent reporting of drug payment information among third-party contractors...