CMS proposes higher cost-sharing on Medicaid

States would be able to establish higher cost-sharing levels for non-preferred drugs covered by Medicaid under a proposed rule CMS issued on Monday. For preferred drugs, CMS proposed a maximum out-of-pocket of $4 for enrollees regardless of income level. For non-preferred drugs, the agency proposed a maximum of $8 for enrollees with family income levels at or below 150% of the federal poverty level. For enrollees with higher incomes, the out-of-pocket maximum would be 20% of the cost of the drug to CMS.

States may designate a drug as preferred if a pharmacy and therapeutics committee determines the drug is "the most cost effective option within each therapeutically equivalent or therapeutically similar class of drugs," according to the proposed rule. If a state does not differentiate between preferred and non-preferred drugs, then all drugs would be considered preferred. ...