Medicaid and Medicare Part D take up a disproportionate share of both state budgets and state legislators’ attention. NLARx is assisting state legislators with the legal, financial, and practical implications of Part D, including “clawback” payments to the federal government, the impact on Medicare/Medicaid “dual eligibles,” and the shift of drug utilization information and purchasing clout from state governments to the private sector. NLARx has advocated for major reforms in the Medicare drug benefit, including instituting price negotiation, providing for at least one government-run plan, reducing the complexity of the program and eliminating the financial penalties. NLARx is also working with states to develop effective strategies to keep Medicaid pharmaceutical costs down without cutting benefits or compromising patient health, and to recover funds from the pharmaceutical industry for fraud and mismanagement.

Researching this Issue

Model state laws and best practices, testimony supporting these initiatives, background information and research materials on Medicaid and Medicare Part D, including reports, legal materials and news articles, are posted here. Information of federal legislation related to Medicaid and Medicare, as well as materials on pharmaceutical fraud litigation and state False Claims Acts, is also posted on this page. Other relevant materials may be found throughout the website, including the issue pages relating to Pricing, which has information on drug costs and AWP pricing and disclosure; and on PBMs, Preferred Drug Lists, Purchasing Pools, and Generics, since all of these subjects figure in state and federal Medicaid and Medicare policy. See also the Related Links below to connect to other organizations with a primary focus on Medicare and Medicaid litigation and access.