Recent Final Rule Confirms No Wiggle Room for Pharma - PBMs are in the Medicaid Best Price Calculation

By Rachel V. Rose, JD, MBA, Attorney at Law, PLLC, Houston, TX

Introduction

It is widely accepted that prescription drugs play a vital role in the management of both chronic diseases and acute conditions.1 “At the same time, the rate of growth in prescription drug spending has concerned both public and private payers.”2 According to the Kaiser Family Foundation, private insurers, Medicare Part D, and Medicaid account for 82 percent of total retail prescriptions in the United States, which total over $274 billion annually.3

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