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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 .
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.
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.
The Texas Health and Human Services Commission, which operates these programs — called STAR and CHIP — shocked many pediatric providers in Tarrant County in March when it decided not to award ...
One of the 2010 law’s primary means to achieve that goal is expanding Medicaid eligibility to more people near the poverty level. But a crucial Supreme Court ruling in 2012 granted states the power to reject the Medicaid expansion, entrenching a two-tiered health care system in America, where the uninsured rate remains disproportionately high ...
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Texas has the most disenrollments. The Medicaid "unwinding" that began after eligibility checks resumed this year led millions of people to lose coverage. Texas has the most disenrollments.
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]