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The Trump administration on Monday finalized a rule meant to make it easier for state Medicaid programs, commercial insurers and drug manufacturers to enter into value-based arrangements tying prescription drug payments to clinical outcomes.
The rule overhauls existing regulations that stymied value-based payments, CMS said, in a bid to expand access to new, expensive drugs, such as gene therapies. Payers will be able to negotiate prices with drugmakers based on outcomes and evidence-based measures like reduced hospitalizations or lab visits, and won t be accountable for the full price if the value of the drug isn t proven.
The changes are effective in January 2022. CMS estimates the value-based arrangements emerging in the wake of the final rule could save federal and state governments up to $228 million through 2025.
Evofem Biosciences to Participate in Medicaid National Drug Rebate Program for Phexxi® Effective January 1, 2021
Approximately 25 Million Adult Women Covered by Medicaid
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SAN DIEGO, Dec. 22, 2020 /PRNewswire/ Evofem Biosciences, Inc., (NASDAQ: EVFM) today announced it has entered into an agreement with the U.S. Centers for Medicare and Medicaid Services (CMS) to participate in the Medicaid National Drug Rebate Program (NDRP), providing access to Contraceptive choice should not be a luxury available to only some women. Every woman deserves to choose the method that is right for her individual health needs and unique circumstances, said Saundra Pelletier, Evofem s Chief Executive Officer. We are proud to participate in the NDRP, ensuring that millions of women across the nation who rely on Medicaid for healthcare coverage have access to Phexxi for hormone free, on-demand contraception.