Medicaid

Senate Finance Committee Chair Chuck Grassley (R-IA) on Wednesday (Jan. 9) said he expects to spend time looking at Medicare and Medicaid waste, fraud and abuse now that he has resumed the chairmanship, along with health care anti-trust issues.

CMS says in recently released guidance that states do not need to obtain a Medicare denial for certain durable medical equipment coverage before Medicaid, which acts as a secondary payer for those dually eligible for Medicare and Medicaid, can pay for the equipment.

As one of his first actions as governor, California Gov. Gavin Newsom (D) ordered the state health department to consolidate purchasing power for prescription drugs under its Medicaid program.

As 2019 opens with a divided Congress and a partially closed federal government, the debates about what Medicaid should cover and who it should be for show no signs of letting up.

States have proven to be innovators on prescription drug pricing policy so far, and policy watchers expect aggressive action in 2019.

New Republicans joined the Senate health, Finance and Aging committees for the 116th Congress, Senate Majority Leader Mitch McConnell (R-KY) announced on Thursday (Jan. 3).

The Trump administration is expected to keep drug pricing on center stage in 2019 following a flurry of action last year. In 2018, the administration released a 44-page blueprint with ideas and questions on potential ways to lower drug prices and reduce out-of-pocket costs, and HHS, FDA and CMS proposed a torrent of regulations and notices.

CMS is automating the system that determines whether drugs are properly classified in the Medicaid Drug Rebate Program as Congress gets closer to giving CMS the power to force drug reclassifications to recoup Medicaid rebates, according to a letter CMS sent earlier this year to Sen. Chuck Grassley (R-IA), who wrote the Medicaid-rebate bill.

Legislation to recoup unpaid Medicaid drug rebates has run into trouble in the Senate, even though observers had been optimistic just days ago that the upper chamber would pass the measure.