CMS finalizes ACA Rule to save US taxpayers billions

In order to effectively implement provisions of the Affordable Care Act, the US Centers for Medicare and Medicaid Services (CMS) finalized a rule last week detailing reforms to the rebate and reimbursement systems for Medicaid prescription drugs, which will save federal and state governments an estimated $2.7 billion over five years.

By April 1, state Medicaid agencies must start reimbursing pharmacies for prescription drugs based on actual acquisition costs according to the final rule. Medicaid programs until now have reimbursed pharmacies for prescription drugs based on the ingredient costs for the drug and a dispensing fee for filling the prescription, according to the Kaiser Family Foundation.

The Affordable Care Act substantially reformed Medicaid payments for prescription drugs, increasing rebates and setting limits on federal reimbursements.  The “Covered Outpatient Drugs” final rule ensures those reforms will be effectively implemented by providing further detail on how those reimbursements and rebates are calculated, part of CMS’ broader efforts to help ensure affordability and accessibility of prescription drugs, while supporting pharmaceutical innovation.