CMS Rejects Massachusetts Request to Restrict Medicaid Drug Formulary

by | Jul 3, 2018 | Family Voices, NCFPP, Washington Update

The Massachusetts Medicaid program asked the Centers for Medicare and Medicaid Services (CMS) to waive several different requirements of Medicaid law pursuant to the federal government’s waiver authority granted in section 1115 of the Social Security Act. Among the state’s proposals was one to strictly limit the prescription drugs covered by Medicaid. Numerous patient groups opposed the state’s proposal. CMS denied the state’s request, without a clear rationale, but suggested it would consider letting the state restrict its drug formulary if the state waived Medicaid drug rebates and instead negotiated prices directly with drug manufacturers. See the CMS letter, page 2. See the press release from the Cancer Action Network commending the decision to deny the Massachusetts’s request.

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