Feds reject Baker bid to rein in pharmacy costs
State sought to restrict access to some MassHealth drugs
THE FEDERAL GOVERNMENT on Wednesday rejected a bid by the Baker administration to rein in pharmacy spending by restricting which drugs would be covered under its MassHealth program.
“While it is disappointing that our request to more effectively control rising pharmacy costs was not approved at this time, we remain committed to finding more innovative state-based solutions to reduce the growth in drug spending while maintaining access to necessary medications,” said a Baker administration spokeswoman in a statement.
Pharmacy spending is a growing concern with MassHealth, the state’s Medicaid program. In just the last five years, pharmacy spending has doubled from $1.1 billion to $2.2 billion. Officials say a significant part of the spending growth is driven by a relatively small number of drugs with little or no competition.
The Baker administration sought a waiver from the Center for Medicare and Medicaid Services to establish its own policies about which drugs would be covered. Normally, Medicaid drug programs cover all medications with only minor restrictions. Analysts say the Massachusetts request was the first of its kind in the nation.
Officials said 30 top drugs currently account for $600 million in MassHealth pharmacy costs. The officials said another 19 medications that have either recently been approved or nearing approval are expected to increase costs more than $80 million annually.