The Centers for Medicare & Medicaid Services (CMS) must withdraw unprecedented changes to Medicaid that will cause higher drug acquisition costs for infusion providers and restrict patient access.

In the summer of 2023, the Centers for Medicare and Medicaid Services (CMS) proposed unprecedented and dangerous changes to the Medicaid Drug Rebate Program (MDRP) to require drug manufacturers to “stack” or aggregate all drug discounts provided throughout the healthcare supply chain, like pharmacies, wholesalers, or infusion providers.

The Problem

Commonly referred to as the “stacking” policy, the proposed changes from CMS would require drug manufacturers to add up all the rebates and discounts for a unit of a medicine provided to determine the “best price” in Medicaid. The Implications The CMS proposed “stacking” policy is a form of government overreach and could lead to higher drug acquisition prices for infusion providers, leading to restricted access to life-saving drugs for infusion patients.

What Is NICA Doing About This?

The National Infusion Center Association (NICA) urges the Centers for Medicare & Medicaid Services (CMS) to withdraw or delay the proposed “stacking” policy. Take Action! Send a letter to your Member of Congress now urging them to tell CMS to withdraw the “stacking” rule.

What Advocates Are Saying:

“While we commend CMS for continuing to propose solutions intended to reduce costs for Medicaid beneficiaries, every policy should be evaluated on its impact across the entire healthcare ecosystem to mitigate unintended consequences. It is imperative that CMS withdraw the stacking policy to protect providers and vulnerable patients who rely on access to essential treatments to optimize their health and well-being.” – Brian Nyquist, MPH, President and Chief Executive Officer (CEO) of the National Infusion Center Association (NICA).

“For instance, would the new best price rule reduce clinical and financial risk for Medicaid beneficiaries — who already face no or extremely low co-pays for prescriptions — or would it merely save the government money? And would those savings come at the cost of depressing investment in new and innovative treatments? The rule’s potential deterrent effect on drug research must not be discounted, especially since Medicaid recipients have higher rates of disabilities and chronic conditions than other covered individuals in the public and private sectors.” – Gary A. Puckrein, President & Chief Executive Officer Of The National Minority Quality Forum (NMQF)

“Incorporating the stacking of multiple discounts is not a determination of best price, but a commentary on a complex system that requires a multitude of transactions. Particularly for smaller innovator companies with limited product lines, this complex marketplace can be challenging to navigate. Incorporating aspects of not one but all transactions into the calculation of the best price can make bringing a potentially life-changing therapy to market even more challenging.” – Margarita Valdez Martínez, Director of Policy and Advocacy, American Society of Gene + Cell Therapy.