Outpatient prescription drug coverage is an optional Medicaid benefit that all 50 states and DC have opted to provide. State Medicaid programs establish their own payment design for outpatient prescription drugs within parameters established by the federal government. The entrance of high-cost specialty drugs into the market and rising prices for generic drugs are contributing to cost increases for public and private payers. However, the rate of drug spending growth is higher in Medicaid compared to other insurers. The purpose of this briefing is to inform federal policymakers and stakeholders to the legislative and regulatory actions that state officials are pursuing to address the rising cost of prescription drugs in Medicaid. The event featured prominent state officials from Oklahoma and Colorado, and the director of the CMS Division of Pharmacy at the Center for Medicaid and CHIP Services. Panelists outlined the rationale for these actions, detail the mechanisms of state policies, and described opportunities to leverage flexibility within federal parameters.
- Shawn Bishop, MPP, vice president, Controlling Health Care Costs and Advancing Medicare, The Commonwealth Fund
- Mary Ella Payne, MSPH., R.N., acting president and chief executive officer, Alliance for Health Policy
- John Coster, Ph.D., R.Ph., director, Division of Pharmacy, Center for Medicaid and CHIP Services, Centers for Medicare and Medicaid Services
- Trish Riley, M.S., executive director, National Academy for State Health Policy
Terry Cothran, R.Ph., director, Pharmacy Management Consultants, University of Oklahoma College of Pharmacy
- Cathy Traugott, R.Ph., J.D., pharmacy clinical manager, Client and Clinical Care Office, Colorado Department of Health Care Policy & Financing
The Alliance for Health Policy gratefully acknowledges the support of The Commonwealth Fund for this event.