NASHP Releases Model Legislation Tying State Drug Pricing to Medicare Negotiated Rates
The National Academy for State Health Policy published revised model legislation allowing states to reference Medicare Maximum Fair Prices negotiated under the Inflation Reduction Act when setting prescription drug payment rates for state programs. The model act would apply to state-funded programs including Medicaid fee-for-service and potentially managed care pharmacy benefits. States can adapt the model to tie reimbursement rates to Medicare's negotiated prices for high-cost drugs, creating potential benchmark pricing constraints. The legislation offers states a mechanism to leverage federal negotiating power for prescription drug cost containment.
Medicaid MCOs with pharmacy risk may face state-mandated maximum reimbursement rates linked to Medicare negotiated prices, affecting pharmacy benefit management strategies and capitation rate adequacy for high-cost drugs.
Pharmacy · Managed Care · Finance
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