Medicare Agent News: CMS released the Establishing Minimum Standards in Medicaid State Drug Utilization Review and Supporting Value-Based Purchasing for Drugs Covered in Medicaid, etc.; Delays of Effective and Inclusion Dates Proposed Rule (CMS-2482-P2)

Wednesday, May 26, 2021

CMS released the Establishing Minimum Standards in Medicaid State Drug Utilization Review and Supporting Value-Based Purchasing for Drugs Covered in Medicaid, etc.; Delays of Effective and Inclusion Dates Proposed Rule (CMS-2482-P2)

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Today, the Centers for Medicare & Medicaid Services (CMS) released the Medicaid Program; 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: Delay of Effective Date for Provision Relating to Manufacturer Reporting of Multiple Best Prices Connected to a Value-Based Purchasing Arrangement; Delay of Inclusion of Territories in Definition of States and United States Proposed Rule (CMS-2482-P2) at the Office of the Federal Register.

As the U.S. continues to battle COVID-19, ensuring Americans have meaningful access to safe, affordable health care and medications has never been more critical. With the NRPM that was published today, CMS is proposing a delay of six months to the multiple best-price provisions related to VBP arrangements and the reporting of multiple best prices to CMS for purposes of the Medicaid Drug Rebate Program (MDRP), which is now proposed to become effective July 1, 2022. In the current rule, it would go into effect January 1, 2022.

CMS originally published the final rule on December 31, 2020, to build on the work that CMS has done over the last six years to lower drug prices for Medicaid beneficiaries, and increase access to these high-cost medications. The final rule also had provisions that promote Medicaid drug rebate program accountability and integrity, and implement provisions to improve the clinical use of opioids and reduce the potential for abuse in Medicaid patients.

Additionally, CMS is proposing a two-year delay in the effective date for the inclusion of the five U.S. territories in the MDRP program from April 1, 2022 until April 1, 2024. CMS could determine an earlier effective date for inclusion of the territories if comments support such a date, but no sooner than January 1, 2023. These delays will ensure that states and territories are able to focus on responding to the ongoing Public Health Emergency.