Navigating Medicaid and Medicaid Managed Care, From Launch to Ongoing Product Management
Time: 9:00 am
day: Conference Day One
Details:
- Medicaid Landscape & Coverage Control: CNS drug access is highly influenced by state-level policies, with Fee-for-Service (FFS), Managed Medicaid (MMC), statewide Preferred Drug Lists (PDLs), and carve-outs driving coverage decisions. Antipsychotics are often treated as a protected class, though policies vary by state
- Preferred Drug Lists & Rebating: Nearly all states now operate PDLs to manage costs. CNS drugs face challenges because most classes are dominated by generics, making supplemental rebates critical for new branded agents to gain favorable positioning
- Post-Launch Review Mechanisms: Drug Utilization Review (DUR) Boards and Pharmacy & Therapeutics (P&T) Committees evaluate CNS products for clinical criteria, PDL placement, and prior authorization requirements. Engagement in these forums is key for influencing access
