Burden of USA CMS rules on outpatient drugs

The US Centers for Medicare and Medicaid Services (CMS) will today formally release a proposed rule implementing sections 2501, 2503, and 3301 of the Affordable Care Act. The 202-page proposal would regulate outpatient drugs under Medicaid. More specifically, it would increase the minimum rebate percentage for “single source and innovator multiple source drugs,” comments the think tank American Action Forum.

In brief, the AAF notes the following implications of the covered outpatient drugs rule breakdown:

• Imposes new conditions on managed care organizations (MCO) that dispense covered drugs under Medicaid. MCO’s must now establish rates “based on actual cost experience.”