Posted by Michael Wonder on 12 Aug 2020
CMS proposes changes to Medicaid best price rule: a potential boost to value-based contracting
9 August 2020 - For well over a decade policymakers have declared the healthcare system is moving towards value-based pricing of services and technologies.
However, the movement from volume- to a value-based system of pricing has occurred at a snail’s pace, especially in the pharmaceutical sector. Numerous barriers have prevented value-based pricing from being implemented.
Now, one of those barriers, namely Medicaid’s “best price” rule, may change, to accommodate value-based pricing arrangements. In June, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule change to adapt (update) the best price rule to the modern era of value-based pricing. Rather than only allowing one best price for each drug, CMS is permitting arrangements in which there is more than one price for a drug, based on health outcomes.
