Radar on Medicare Advantage, a subscription publication of AIS Health, featured L.A. Care's chief medical officer Dr. Richard Seidman in "Budget Shows Promise of Replacing Outdated MDRP." The piece talks about President Trump's proposed fiscal year 2019 budget that contains several reforms aimed at restructuring drug benefits in both Medicare and Medicaid.
Richard Seidman, M.D., chief medical officer at L.A. Care Health Plan, says the publicly operated health plan would be generally supportive of the concept of closed formularies with a robust appeals process. "This would result in decreased drug costs because the states would be able to leverage one manufacturer’s product against another manufacturer’s product for formulary placement, creating competition," he tells AIS Health.
"As a managed care plan, we have in place a very prudent and careful process on placing drugs on our formulary already, and this would give us even more flexibility and opportunity," Seidman adds.
Key changes proposed by the budget include allowing states to design their own drug formularies — as opposed to the current system of requiring all FDA-approved medications to be included on a formulary, but with a preferred or nonpreferred designation. Another allows states to negotiate drug prices directly with manufacturers. Most manufacturers sign a national agreement to have their products covered through the Medicaid Drug Rebate Program (MDRP).
Radar on Medicare Advantage is a biweekly publication that provides strategies and analysis of Medicare Advantage, Medicare Part D and managed Medicaid reimbursement.
About L.A. Care Health Plan
L.A. Care Health Plan is a public entity and community-accountable health plan serving residents of Los Angeles County through a variety of health coverage programs including L.A. Care Covered™, Medi-Cal, L.A. Care Cal MediConnect Plan and PASC-SEIU Homecare Workers Health Care Plan. L.A. Care is a leader in developing new programs through innovative partnerships designed to provide health coverage to vulnerable populations and to support the safety net. With more than 2 million members, L.A. Care is the nation’s largest publicly operated health plan.