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The Medicaid Drug Rebate Program is a program in the United States that was created by the Omnibus Budget Reconciliation Act of 1990 (OBRA'90). The program establishes mandatory rebates that drug manufacturers must pay state Medicaid agencies related to the dispensing of outpatient prescription drugs covered by Medicaid .
More than 94 million Americans were enrolled in the program as of April 2023, and over 12.5 million seniors are eligible for both Medicare and Medicaid at the same time.
That includes 41.7 million adults enrolled in Medicaid and 37.6 million Medicaid child and Children's Health Insurance Program enrollees. Medicaid enrollment is on the rise, with the program ...
In response, states like Ohio, West Virginia, and Louisiana have taken action to regulate PBMs within their Medicaid programs. For instance, they have created new contracts that require all discounts and rebates to be reported to the states. In return, Medicaid pays PBMs a flat administrative fee. [19]
State Medicaid programs must administer their coverage of prescription outpatient drugs in a manner that accounts for participation in the 340B Drug Pricing Program. Typically, state Medicaid programs obtain rebates for dispensed outpatient prescription drugs through the Medicaid Drug Rebate Program. However, duplicate discounts are prohibited.
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Iowa and Michigan follow Arkansas’ lead when their Republican governors and legislatures enact privatized variations of the Medicaid expansion. Oct. 2013. Ohio Gov. John Kasich (R) circumvents the Republican majority in the legislature and expands Medicaid via an obscure budgetary mechanism, a maneuver later affirmed by the state Supreme Court.
Section 1115 Research & Demonstration Projects: States can apply for program flexibility to test new or existing approaches to financing and delivering Medicaid and CHIP. Section 1915(b) Managed Care Waivers: States can apply for waivers to provide services through managed care delivery systems or otherwise limit people's choice of providers.