Content about Medicaid

PITTSBURGH — Generic drug maker Mylan has settled a lawsuit concerning Medicaid reimbursements with the federal government and the state of Texas, Mylan said Dec. 24.

Under the settlement, Mylan will pay $65 million.

Several state attorneys general filed lawsuits against Mylan and other drug companies in September 2003 over Medicaid reimbursements, alleging that the companies defrauded the programs by reporting average wholesale prices greater than the prices of their prescription drugs, thus causing the programs to make excessive payments to healthcare providers.

A budgetary crisis in Washington state has spawned new threats to pharmacy retailers as lawmakers and Gov. Chris Greqoire grapple with an expected shortfall of $1.4 billion in 2011.

WHAT IT MEANS AND WHY IT’S IMPORTANT — It’s a battle that raged for more than three years. But in mid-December, the retail pharmacy industry was able to declare a clear, unequivocal victory.

(THE NEWS: In landmark victory for retail pharmacy, feds agree to drop last AMP provisions. For the full story, click here)

ALEXANDRIA, Va. — In a clear victory for retail pharmacy, the National Association of Chain Drug Stores and the National Community Pharmacists Association have agreed with the Centers for Medicare and Medicaid Services on a motion to dismiss the Medicaid average manufacturer price lawsuit. The landmark agreement came after CMS withdrew the last remaining provisions of the AMP rule that had been blocked by a preliminary injunction following litigation by NACDS and NCPA.


BENTONVILLE, Ark. — It’s the kind of low-price power play that gives smaller-scale independent pharmacy owners — and chain drug store operators too, for that matter — the willies. In what promises to be another potent and potentially market-altering exercise in massive scale and competitive clout, Walmart has linked up with insurance heavyweight Humana to launch what it says will be the lowest-cost prescription drug plan for seniors who rely on Medicare Part D prescription drug coverage.


BALTIMORE — The Centers for Medicare and Medicaid Services on Tuesday formally established the new Center for Medicare and Medicaid Innovation.

Established by the Affordable Care Act, the Innovation Center is charged with finding new ways of delivering health care and paying healthcare providers in an effort to save money for Medicare and Medicaid while improving the quality of care. CMS also announced the launch of new demonstration projects that will support efforts to better coordinate care and improve health outcomes for patients.

LOUISVILLE, Ky. — Humana and Wal-Mart Stores on Monday announced that Mary Lee Reinscheld became the first Medicare beneficiary to sign up for the new Humana Walmart-Preferred Rx Plan at one of the Humana informational kiosks available in approximately 3,000 Walmart stores nationwide.

Reinscheld signed her Humana application at Walmart store No. 1170 here as the annual enrollment period for Medicare beneficiaries, including seniors and people with disabilities, got under way.

ALEXANDRIA, Va. Budget cuts in Washington state to its Medicaid programs have created a “perilous situation” for retail pharmacies and their patients, the National Association of Chain Drug Stores warned on Wednesday, and could “pose danger as a precedent for other states across the nation as well,” according to the group.

With strong support from pharmacy leaders, Congress is moving to shut down prescription medication abuse and diversion with a multipronged legislative cudgel.

Prior to its October recess, the U.S. House of Representatives passed three industry-backed bills in September to help seal up the nation’s leaky prescription drug pipeline. The bills are expected to pass under “suspension of the rules,” which allows for expedited consideration of legislation.

ALEXANDRIA, Va. The National Community Pharmacists Association is urging the Centers for Medicare and Medicaid Services to follow guidance that Congress included in the healthcare-reform law in its implementation of a new Medicaid generic drug reimbursement formula based on average manufacturer price, the organization said Tuesday.

CMS recently withdrew provisions that would have dramatically cut Medicaid pharmacy reimbursement to community pharmacies from a previously proposed AMP rule due to an injunction that the NCPA obtained in 2007.

WASHINGTON Due to the nation’s deep recession, states experienced rapid growth in their Medicaid enrollment and spending last year and expect additional growth, though at a slower pace, in fiscal year 2011, according to a survey of state Medicaid officials in all 50 states released Thursday by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.