Oklahoma's SoonerCare Starting Refund Program For Failed Medications

As healthcare costs continue to rise Oklahoma will soon become the first state with a Medicaid agency allowed to negotiate with drug-makers if their medicine doesn't work.

In March, the Oklahoma Healthcare Authority submitted a state plan amendment proposal to the Centers for Medicare & Medicaid Services. Last week they announced that they have received the go-ahead to start a program asking drug companies for reimbursement if a drug doesn't help patients.

“In essence, this means that if a drug does not perform as claimed, the manufacturer will rebate the cost of the drug or another negotiated amount. For example, if a drug claims to keep people out of the hospital and doesn't, the manufacturer may be liable for the cost of the hospitalization,” said OHCA Pharmacy Director Nancy Nesser.

According to OHCA, drug companies won’t be required to take part in the program. The agency has initiated talks with 20 companies of which 10 are currently actively engaged in discussions or are in contract negotiations.

An OHCA release states "value-based contracts" are part of their work to provide the best care possible for SoonerCare members.