Medicaid Prescription Drugs: Pricing and Policy Issues

Sandra Olivia Barton (Editor)

Series: Health Care in Transition
BISAC: LAW093000



Volume 10

Issue 1

Volume 2

Volume 3

Special issue: Resilience in breaking the cycle of children’s environmental health disparities
Edited by I Leslie Rubin, Robert J Geller, Abby Mutic, Benjamin A Gitterman, Nathan Mutic, Wayne Garfinkel, Claire D Coles, Kurt Martinuzzi, and Joav Merrick


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Medicaid is a federal-state entitlement program that pays for health care and related services on behalf of certain low-income individuals. Prescription drugs are an optional Medicaid benefit and all states cover outpatient drugs. States can create formularies, or lists of preferred drugs, but federal rules tend to result in comprehensive coverage, even for beneficiaries enrolled in Medicaid managed care plans.

Pharmaceutical manufacturers that voluntarily participate in Medicaid are required to pay rebates to states on covered outpatient drugs, which help Medicaid receive manufacturers’ lowest or best price. States then share the rebate they receive from pharmaceutical manufacturers with the federal government. This book discusses Medicaid prescription drug pricing and policies. (Imprint: Nova)


Chapter 1 - Medicaid Prescription Drug Pricing and Policy (pp. 1-80)
Cliff Binder

Chapter 2 - Medicaid Prescription Drugs: CMS Should Implement Revised Federal Upper Limits and Monitor Their Relationship to Retail Pharmacy Acquisition Costs (pp. 81-116)
United States Government Accountability Office

Index 117

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