How does the government determine how to pay for drugs for Medicaid beneficiaries?


State Medicaid programs and the federal government have been looking for new ways to determine payment for Medicaid-covered drugs. In the coming months, the Centers for Medicare & Medicaid Services (CMS) will be issuing a proposed rule to change the determination from an “estimated acquisition cost” to an “actual acquisition cost.” The goal is to more accurately reflect pharmacies’ purchase prices and, of course, to save money for the government.


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