News & Analysis as of

Medicaid › Value-Based Purchasing

Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with... more +
Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with children.  less -
Mintz - Health Care Viewpoints

Medicaid Best Price 101: A Review of Medicaid Best Price Policy and New CMS Guidance on Medicaid Best Price Reporting for Value...

Mintz - Health Care Viewpoints on

At the end of March 2022, the Centers for Medicare & Medicaid Services (CMS) released guidance to drug manufacturers and states on reporting Medicaid Best Price under value based purchasing (VBP) arrangements (Medicaid Best...more

Blank Rome LLP

The Medicaid Drug Rebate Program and Value-Based Purchasing

Blank Rome LLP on

On March 23, 2022, the Centers for Medicare and Medicaid Services (“CMS”) issued long-awaited guidance regarding how drug manufacturers are to report multiple best prices (“BPs”) to the Medicaid Drug Rebate Program (“MDRP”)...more

Foley Hoag LLP - Medicaid and the Law

How does Pfizer’s New Warranty Program for XALKORI get around Medicaid Best Price?

Foley Hoag LLP - Medicaid and the Law on

On October 13th our friends over at STAT broke the news [sorry, Paywall] about a “warranty” pilot program from Pfizer that offers both patients and health plans (including Medicare Part D plans) the opportunity to receive a...more

Foley Hoag LLP - Medicaid and the Law

CMS Issues New Guidance for States to Address Social Determinants of Health

Foley Hoag LLP - Medicaid and the Law on

The social determinants of health (SDOH) describe the range of environmental, social, and economic factors that can impact health outcomes. According to the Centers for Disease Control and Prevention (CDC), the conditions in...more

Foley Hoag LLP - Medicaid and the Law

A Deeper Dive into CMS’ Multiple Best Prices Policy

Foley Hoag LLP - Medicaid and the Law on

As my colleague Tom wrote about in a recent post, the Centers for Medicare & Medicaid Services (CMS) has finally responded to a growing chorus of stakeholders that government price reporting requirements, particularly...more

Foley Hoag LLP - Medicaid and the Law

CMS Finalizes Changes to Medicaid Prescription Drug Rebate Program

Foley Hoag LLP - Medicaid and the Law on

Earlier this year, my colleague Ross Margulies and I told you about a new proposed rule issued by CMS that makes several changes to the Medicaid prescription drug rebate program, or the MDRP. Recently, CMS finalized the rule...more

King & Spalding

Final Rule on VBP, Patient Assistance and Line Extensions Presents Opportunity and Risk for Drug Manufacturers

King & Spalding on

Trump Administration Finalizes Rulemaking on Value-Based Purchasing, Multiple Best Prices, Expanded Alternative URA, and other MDRP Drug Pricing Changes - On December 21, 2020, the Centers for Medicare & Medicaid Services...more

Sheppard Mullin Richter & Hampton LLP

CMS’ Proposed Rule Promoting Value-Based Purchasing for Medicaid-Covered Drugs: The Comments are In!

Sheppard Mullin Richter & Hampton LLP on

On June 19, 2020, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, “Medicaid Program; Establishing Minimum Standards in Medicaid State Drug Utilization Review (DUR) and Supporting Value-Based...more

Foley Hoag LLP - Medicaid and the Law

Paying for Value in Medicaid Prescription Drug Coverage

Foley Hoag LLP - Medicaid and the Law on

My colleague Ross Margulies has already told our readers about a provision of the new proposed Medicaid regulation governing how the program pays for outpatient prescription drugs under the Medicaid Drug Rebate Program, or...more

Mintz - Health Care Viewpoints

CMS Proposes Rule to Pave the Way for Value-Based Drug Purchasing

Mintz - Health Care Viewpoints on

The Centers for Medicare & Medicaid Services (CMS) has taken another step to further the adoption of value-based purchasing within the health care industry. (Readers may recall the Department of Health & Human Services’ two...more

ArentFox Schiff

Proposed ‘Kitchen Sink’ Medicaid Rule Could Bring Changes for Pharmaceutical Manufacturers

ArentFox Schiff on

The Centers for Medicare & Medicaid Services (CMS) published a Proposed Rule on June 19, 2020 (the Proposed Rule) which, among other things, suggests updates to Medicaid policies and practices related to drug pricing and...more

King & Spalding

New Risks, New Rewards, New Exposure

King & Spalding on

Value-Based Purchasing, Multiple Best Prices, Expanded Alternative URA, and other MDRP Drug Pricing Changes in Proposed Rule - On June 17, 2020, the Centers for Medicare & Medicaid Services (“CMS”) released a major...more

Hogan Lovells

Medicaid Drug Rebate Program proposed rule on value-based pricing, line extension, PBM accumulators

Hogan Lovells on

On June 17, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a Proposed Rule (link) that would materially modify current Medicaid Drug Rebate Program (MDRP) regulations. Comments are due no later than 5:00 p.m....more

Holland & Knight LLP

CMS Releases Fiscal Year (FY) 2020 Inpatient Prospective Payment System (IPPS) Final Rule

Holland & Knight LLP on

On August 2, 2019, the Centers for Medicare and Medicaid Services (CMS) released the Fiscal Year (FY) 2020 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital Prospective Payment System...more

Manatt, Phelps & Phillips, LLP

Extending VBP Models Into Medicaid Drug Purchasing

Manatt, Phelps & Phillips, LLP on

Editor’s Note: Over the past decade, both public and private payers have sought to develop payment policies that emphasize the value of the services provided instead of the quantity. These value-based purchasing (VBP)...more

Smith Anderson

The ACO Specialist Manual

Smith Anderson on

The ACO Specialist Manual is a strategic guide to getting the optimum value-add contributions from each medical specialty in integrated health care. For purposes of this Manual, the teams are generally termed accountable care...more

Manatt, Phelps & Phillips, LLP

Manatt on Medicaid: 10 Trends to Watch in 2018

Manatt, Phelps & Phillips, LLP on

Medicaid has entered a period of volatile change, unprecedented in its 51-year history. With 74 million members nationwide,1 Medicaid provides health coverage to more than one in four Americans, ensuring access to...more

King & Spalding

CMS Issues IPPS and LTCH PPS Final Rule for FY 2018

King & Spalding on

On August 2, 2017, CMS issued the Fiscal Year (FY) 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System Final Rule (Final Rule) that updates...more

Foley & Lardner LLP

10 Things You Need to Know About Health Care Bankruptcies in 2017

Foley & Lardner LLP on

The coming year will likely continue to be a tumultuous year for health care providers, suppliers, and payers, as they adapt to meet new challenges and market forces, particularly in light of the open questions as to the...more

Manatt, Phelps & Phillips, LLP

Manatt on Health Reform: Weekly Highlights - July 2016 #3

Manatt, Phelps & Phillips, LLP on

Massachusetts’s Marketplace eliminates cost-sharing for addiction treatment in subsidized QHPs; Montana cuts its uninsurance rate in half; and a Kaiser report identifies the 50 most costly drugs for Medicaid....more

Foley & Lardner LLP

CMS Update to Medicaid Managed Care Regulations Should Prompt Significant Change

Foley & Lardner LLP on

The Centers for Medicare & Medicaid Services (“CMS”) has released the final version of its much anticipated revisions to the regulations governing Medicaid managed care (the “Final Rule”). First proposed in May 2015, the...more

Manatt, Phelps & Phillips, LLP

Manatt on Medicaid: CMS Approves California's Delivery System Reform Incentive Payment (DSRIP) Waiver Renewal

Manatt, Phelps & Phillips, LLP on

On December 30, 2015, the Centers for Medicare and Medicaid Services (CMS) approved California's request to renew its waiver under Section 1115 of the Social Security Act. A significant component of the waiver is the Delivery...more

Foley & Lardner LLP

CMS Approves California’s Section 1115 Medicaid Demonstration

Foley & Lardner LLP on

The Centers for Medicare and Medicaid Services (CMS) has approved a new section 1115 Medicaid demonstration for the state of California. Under the demonstration, the California Department of Health Care Services (DHCS) will...more

King & Spalding

Also In The News - Health Headlines - November 2015

King & Spalding on

CMS Publishes Medicaid Access Final Rule – CMS published a Final Rule in the Federal Register today, November 2, 2015, that implements a process for states to determine whether Medicaid payments satisfy what is known as the...more

BakerHostetler

The Deeper Dive: Medicare’s Fundamental Shift Toward P4P - What priorities should providers focus on in navigating the changing...

BakerHostetler on

While Medicare’s path toward pay for performance (P4P) has evolved over time, 2015 is proving to be a landmark year. July marked the 50th anniversary of the Medicare program. And in self-described “historic announcements”...more

38 Results
 / 
View per page
Page: of 2
Next »

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up Log in
*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
- hide
- hide