Notice of Proposed Rulemaking: Establishing Minimum Standards in Medicaid State Drug Utilization Review (DUR) Programs and Supporting Value-Based Purchasing (VBP) for Drugs Covered in Medicaid, Revising Medicaid Drug Rebate and Third Party Liability (TPL) Requirements

Today, the Centers for Medicare & Medicaid Services (CMS) released the proposed rule entitled: Establishing Minimum Standards in Medicaid State Drug Utilization Review (DUR) Programs and Supporting Value-Based Purchasing (VBP) for Drugs Covered in Medicaid, Revising Medicaid Drug Rebate and Third Party Liability (TPL) Requirements.  This proposed rule would modernize regulations that have inhibited value-based payment arrangements for prescription drugs and would encourage discounts based on drug effectiveness, a critical step as lifesaving, but expensive new treatments come onto market.  It also creates minimum standards in state Medicaid Drug Utilization Review (DUR) programs designed to reduce opioid-related fraud, misuse and abuse. Additionally, it makes updates to the current Medicaid drug rebate requirements to align with the changes to the statute and marketplace.

Learn more here:

• CMS Press Release
• CMS Fact Sheet
• Notice of Proposed Rulemaking: Establishing Minimum Standards in Medicaid State Drug Utilization Review (DUR) Programs and Supporting Value-Based Purchasing (VBP) for Drugs Covered in Medicaid, Revising Medicaid Drug Rebate and Third Party Liability (TPL) Requirements