Medicaid payments for prescription drugs are determined by a complex set of measures, both federally and nationally, that rely on price benchmarks to determine both ingredient costs and discounts under the Federal Medicaid Drug Rebate Program (MDRP). States set guidelines under federal cost-sharing guidelines for recipients, while federal provisions guide the method of payment for reimbursement of prescription drugs and compensation costs for occupational drugs. The final costs for Medicaid are then offset by rebates granted under the federal MDRP. In addition to the Federal Government`s MDRP legal rebates, most states negotiate additional rebates with manufacturers on medically prescription drugs, with placement on a LDP often used as leverage. States have also created multi-state purchasing pools when negotiating additional medicaid rebates to increase their bargaining power. In addition, most MCO countries allow their MCOs to negotiate their own complementary rebate agreements with producers. Some states have also used their additional rebate power to negotiate alternative payment models with manufacturers, and states continue to be interested in these agreements. A small number of states use limited networks of pharmacies for specialty drugs. Unlike MOOs, which sometimes limit the size of supplier networks, including retail pharmacy networks (if the state allows) for better pricing or higher quality, Medicaid FFS programs typically register « all willing suppliers, » qualified and qualified. However, three states reported selective contracts or limited network agreements for FFS special pharmacy drugs effective July 1, 2019: Arizona obtained a supplier that provides specialized pharmaceutical services for anti-hemophilia products and other anti-hemophilia drugs; Pennsylvania has competitively purchased two preferred suppliers to provide drugs, by-products and services and clinical assistance; In 2010, DC and DC established a network of specialized mental health pharmacies to enable selected injection injection antipsychotics to obtain billing as a pharmacy advantage through the point-of-sale pharmacy system.

Pharmacies that wish to transmit these drugs directly to medical practices or other health facilities may register as suppliers to this network of pharmacies. No state reported a limited network of ffs for non-specialized drugs. Chart 9: Countries that allow McO and PBM to negotiate additional rebates from July 1, 2019, a small but growing number of states are using alternative payment methods to increase additional rebates negotiated with individual pharmaceutical manufacturers through value-based agreements (VbA). Two states reported that a VBA was in effect on July 1, 2019: Oklahoma reported four APAs, including two long-term injectable antipsychotics and one epilepsy drug and one antibiotic primarily used in the emergency room;6 and Washington reported that they had a modified VBA subscription model (also known as « Netflix ») for antiviral drugs against hepatitis C.7 ,8 Other states (Arizona) Arkansas, Arkansas, Georgia, Indiana, Louisiana, Massachusetts and Michigan reported plans to submit a VBA state plan to CMS or implement a VBA in GJ 2020, and eight states (Connecticut, DC, Idaho, Kentucky, New Jersey, North Carolina, South Carolina and Virginia) indicated that VBAs would be reviewed or studied. Most countries use competitive purchases to choose a unit to negotiate additional discounts, and a majority of states with additional discounts rely on a purchase reserve to negotiate discounts. Of the 46 states reporting additional rebate programs, 24 reported that a pool of purchases negotiated, six