CMS Releases Covered Outpatient Drug Rule; Clarifies 340B in Managed Care

1 Feb 2016

The Centers for Medicare and Medicaid Services (CMS) issued its long awaited regulations on Medicaid reimbursement and rebates for so-called “covered outpatient drugs” today.  The rule is relevant to RWCs because drug manufacturers are required to provide 340B discounts on the same category of drugs.  Perhaps most importantly, the rule clarified that each state has a responsibility for ensuring that 340B drugs billed to Medicaid managed care organizations (MCOs) are not also included in Medicaid rebate requests submitted to drug manufacturers.  In contrast, covered entities are responsible in the fee-for-service Medicaid program for protecting manufacturers against the duplicate discounts that would result if 340B-discounted drugs were also subject to Medicaid rebates.

Category: Medicaid

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