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Webinar: State Tools to Lower Medicaid Prescription Drug Costs – Exploring Payment Methodologies for Retail and Physician-Administered Drugs

Friday, March 29, 2019
2-3 p.m. (EST)

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What payment models are the best options to allow savings?  How do state Medicaid programs know if what they pay pharmacies for retail drugs and providers for physician-administered drugs is appropriate?
As states struggle with increasing prescription drug costs, they are testing various alternative payment models (APMs). Colorado is exploring a first-in-nation payment methodology for how it reimburses providers for physician-administered drugs (PADs). Colorado surveyed providers across a range of practice sites to better understand how much providers are actually paying for drugs. This survey data would inform an average acquisition cost-based payment methodology for PADs with the potential for $3.4 to $12 million in savings in the first year if implemented.

Additionally, researchers at the Johns Hopkins Bloomberg School of Public Health are studying the National Average Drug Acquisition Cost (NADAC) as a payment methodology for retail pharmacies. They are examining the effectiveness of NADAC as a tool for states and whether the use of NADAC has led to cost savings.

The webinar moderator is National Academy for State Health Policy Executive Director Trish Riley. Speakers are:

  • Kevin Martin, BS, Fee for Service Rates Manager, Colorado Department of Health Care Policy and Financing
  • Joseph Levy, PhD, Assistant Scientist, Johns Hopkins Bloomberg School of Public Health
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