[e-drug] Medicaid Rarely Ensures Accuracy of Prescription Drug Prices

["Joana Ramos" <joaninha@comcast.net>]

E-DRUG: Medicaid Rarely Ensures Accuracy of Prescription Drug Prices
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[From the USA< but probably similar problem with insurance systems in developing countries? WB]

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http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=28525

CMS does not enforce a 1990 law that requires pharmaceutical companies to
provide Medicaid with the "best price" for brand-name prescription drugs,
according to a Government Accountability Office report released on Monday,
the New York Times reports.  Under the law, Medicaid only pays for
prescription drugs when pharmaceutical companies agree to provide certain
discounts through rebates to states.  According to the report,
pharmaceutical companies in some cases conceal the best prices from
Medicaid to reduce the amount of the rebates, and CMS in many cases does
not "ensure the accuracy of reported prices."  In addition, CMS does not
require pharmaceutical companies to make corrections when the agency finds
errors or problems with reported prices, the report found (Pear, New York
Times, 3/8).  The report also found "considerable variation" in how
pharmaceutical companies determine the best prices and that CMS does not
provide guidelines for how companies should consider prices negotiated by
pharmacy benefit managers on behalf of private health plans and insurers
(CQ HealthBeat, 3/7).  According to the report, CMS in most cases allows
pharmaceutical companies to use "reasonable assumptions" to determine the
best prices.  GAO officials said that they could not determine the total
amount of federal Medicaid overpayments for prescription drugs. 
Prescription drug expenditures currently account for about 10% of total
Medicaid spending, or about $37 billion of $300 billion this year, the
Times reports.

Reaction


Sen. Chuck Grassley (R-Iowa), who requested the report with Rep. Henry
Waxman (D-Calif.), said that CMS "has been negligent," adding, "For 15
years, drug companies have been profiting from a system that costs
taxpayers untold hundreds of millions, if not billions, of dollars
annually" (New York Times, 3/8).  Grassley added that the GAO report was "a
damning report on Medicaid drug spending" (CQ HealthBeat, 3/7).  In a
written response to the report, CMS officials said that they should provide
"clear guidance" on how pharmaceutical companies should determine the best
prices.  However, the Bush administration denied that CMS provides
"inadequate oversight" over Medicaid and indicated that the federal
government lacked the resources to ensure the accuracy of reported prices
(New York Times, 3/8).

The report is available online.

-- 
Joana Ramos, MSW
Cancer Resources & Advocacy
Seattle, WA  
206-229-2420
http://ramoslink.info/