Medicare Drug Price Negotiation Changes Could Affect Medicaid Best Price Calculations

CMS released draft guidance for the 2028 cycle of Medicare drug price negotiations under the Inflation Reduction Act, expanding eligibility to include Part B drugs for the first time and proposing a single maximum fair price across Part B and Part D. While focused on Medicare policy, these negotiated prices have downstream implications for Medicaid managed care organizations through potential impacts on best price calculations and supplemental rebate agreements. The guidance also refines manufacturer exclusion criteria and seeks comment on how to evaluate therapeutic alternatives.

Pharmacy

This is outside commentary from Avalere, not part of Medicaid Monitor's independently scored news coverage.

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