Even when you are worried about the upcoming Medicaid cuts, they do not collect tens of millions of dollars in drug discounts, in accordance with the report of the government’s supervisory body.
Since 1991, the state agencies Medicaid have the right to claim discounts from pharmaceutical companies. But in the years 2008–2020 the agencies did not collect discounts of USD 392.8 million report Published last spring by the Office of the Inspector of the US Department of Health and Social Welfare.
In addition, it was found that countries should demand discounts with a total value of an unknown amount for another 362.3 million USD drugs. The General Inspector HHS has examined 57 previous state audits of the Medicaid state agencies to develop the latest report.
Just about 6% General Medicaid expenses are allocated to prescription drugs, but the cost increases quickly. Medicaid net expenses (after discounts) on prescription increased by about 72% According to KFF, health research organization.
Medicaid, which provides health care for low -income people, is financed jointly by the federal government and the state. States are preparing for federal cuts in the program as the Trump administration and Congress Republicans Look for ways pay for the extension of tax reductions introduced during the first term of Trump.
Deborah Williams, who worked as an analyst for health policy at Capitol Hill and in several pharmaceutical companies, said that the states have long been struggling with the administrative and technical loads of invoicing for discounts. To apply, state medicaid agencies must collect and transfer data to producers, describing in detail the utilize of drugs saved by Medicaid, within 60 days of the end of each quarter.
“It has been a long -term problem for over 30 years,” said Williams, which currently runs his own consulting company, health policy. “In general, states are underfunded, and the volatility and competences of states … differ dramatically.”
For example, in New York, he left discounts of $ 21 million on the table and should raise an unknown amount of money related to another $ 11.7 million costs.
He spent the state $ 34.7 billion On Medicaid last year, but at a time when Medicaid financing is examined, lost discounts of material, said Robin Feldman, Professor UC Law San Francisco and an expert in the field of pharmaceutical law.
“Every budget is limited. If drug prices were lower, the government could spend these dollars on the expansion of the program or expanding the one who qualifies for the program, “said Feldman in an interview. “Never leave money on the table if possible. This is not good for economic performance and is not good for taxpayers and consumers. “
The report includes so -called drugs administered by a doctor or medicines (other than vaccines) that are often administered or injected in a doctor’s office or in another outpatient environment.
Kimberly Leonard, who supervises the pharmaceutical policy of Medicaid in the Health of New York, said that it is more hard to apply for discounts for medication administered by a doctor than in the case of a bottle of tablets.
Leonard said that in order to get more unsuccessful discounts, New York employed a petite team of pharmacists and accountants to examine claims and employed an external supplier to lend a hand in claims for invoicing.
Antonio Ciaccia, CEO 46Brooklyn Research, Non -Profit organization that examines the data on medicines, acts as a consultant of State Medicaid agencies. He said that some countries are trying to get discounts because they do not have enough people with technical knowledge to review and connect the necessary codes.
“There are massive logistics obstacles that you have to go through to get what the system should give you,” said Ciaccia. He added that the fact that countries must hire consultants like him to demand what they are due is proof of a broken system.
The HHS report recommends that the Federal Government will lend a hand countries to create better internal systems to capture all due discounts.
Williams said that the states of struggle to demand discounts are a symbol of a broader problem: when the programs designed to generate savings are too complicated, ultimately benefit from drug producers and insurance companies – not taxpayers or patients.
“Federal do not intend to assign more administrative dollars to make it work,” said Williams. “If after 30 years, [the states] I could not achieve operational perfection, they will not change it overnight. So this is a structural, systematic and political problem. “
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