Answer: While we welcome this comment, we do not believe that the NDRA is the appropriate means to transmit such user manuals. However, we make it clear that the legal requirements and language of the current rebate contract have not changed with respect to the manufacturer`s payment of rebates in the proposed NDRA, nor has the language of the current rebate contract. Operational guidelines for the application of interest rates after the 37th day from the billing date are available in various program releases, including #29 and #166 and #7 of manufacturers. Program releases are available on www.Medicaid.gov. Home 12777 The rebate program offsets Medicaid costs and reduces federal and federal spending on drugs. In 2017, Medicaid issued $64 billion in drugs and received nearly $35 billion in rebates. Net spending on outpatient drugs accounts for 5% of total spending on Medicaid services. While gross spending on prescription drugs has increased significantly over time (from $43 billion in 2014 to $64 billion in 2017), rebates have pushed net spending growth at a much lower rate (Chart 2). Gross spending on drugs increased by 48% between 2014 and 2017, while net spending increased by only 25% over the same period. Net spending decreased between 2016 and 2017.35 Compared to other programs, such as Medicare Part D, Medicaid rebates account for a much larger share of pharmaceutical spending.
Medicare actuaries predicted Medicare Part D rebates 2017 on 23% of drug spending and 25% in 2018.In contrast, Medicaid rebates accounted for 55% of pharmaceutical spending in 2017. While not specifically focused on Medicaid or MDRP, policy proposals to change the structure of rebates or prices in Medicare and the private market have an impact on Medicaid. These indirect effects occur because many proposals influence list prices or EDP, which affects the calculation of the Medicaid rebate. In early 2019, for example, the Trump administration released a proposed rule that would exclude payment by drug manufacturers to PBMs, Medicare Part D-Plans sponsors and Medicaid Managed Care Organization (MCO) of “safe harbor” protection measures that would have exempted these payments from anti-kickback penalties. The administration withdrew the idea, but analyses of the proposal showed at the time that it would increase Medicaid`s spending. This result would result from lower manufacturers` list prices, which would reduce the inflationary Medicaid rebate.63 Similarly, proposals (such as the administration64 and House Democrats) to bring Medicare drug prices more in line with drug prices in other countries could have an impact on Medicaid rebates and, ultimately, on Medicaid drug spending by changing drug prices. Policy changes that would allow the federal government to: 65 Comment: One commentator suggested that the CMS recognize the need to recognize disputes within a specified time frame and to make the relevant LTC available to manufacturers within a specified time frame, and that cms should revise our amendments to Section V.,d. “Nothing in this section is at odds with the manufacturer`s right to review data on the use of drugs declared (or notified) by the state.