Medicare and Medicaid programs will help Americans reduce drug costs
2023.02.15 14:02
Medicare and Medicaid programs will help Americans reduce drug costs
By Kristina Sobol
Budrigannews.com – On Tuesday, the U.S. Department of Health and Human Services made a proposal for three new pilot projects with the intention of lowering the cost of prescription drugs for people enrolled in government health insurance plans. One of the projects would offer some essential generic drugs for $2 per month.
According to the Centers for Medicare and Medicaid (CMS), the models would be tested in both the Medicaid program for the poor and the Medicare health insurance program, which covers people over 65 and the disabled.
CMS stated that the proposed models would improve access to expensive lifesaving cell and genetic treatments for Medicaid recipients, reduce the out-of-pocket cost of commonly used generic drugs for chronic conditions like hypertension to $2 per month for Medicare beneficiaries, and secure CMS better deals for costly new therapies lacking complete clinical trial data.
The first model proposes that CMS encourage Medicare Part D plans, which cover the majority of prescription drugs, to provide a fixed monthly co-payment of $2 for a standard list of approximately 150 generic drugs that target common conditions among Medicare beneficiaries, such as hypertension and hyperlipidemia. It’s up to you.
The second voluntary model delegated authority to CMS to facilitate contracts and payment models, structure and coordinate multi-state arrangements with manufacturers, and allow state Medicaid agencies to pay for cell and gene therapies.
Additionally, the organization stated that it would work on the creation of a mandatory payment model for drugs that have been approved by the U.S. Food and Drug Administration (FDA) under its Accelerated Approval Program (APP).
Because the pathway does not require the same level of drug efficacy data as the FDA’s regular approval process, CMS has expressed concerns regarding the coverage of Alzheimer’s disease medications under the pathway.
According to CMS, the model, which would be developed in collaboration with the FDA, would address the high cost and lack of confirmed effectiveness of drugs that receive accelerated approval by offering drugmakers incentives to accelerate the completion of confirmatory clinical trials.
It stated that CMS will announce the start date of the first model “as soon as operationally feasible.” The Medicaid gene and cell therapy model’s development will begin in 2023 and be available for testing in 2026. The agency and the FDA will begin working on the accelerated approval model in 2023, but there is currently no set launch date.
