{"id":18266,"date":"2020-01-30T13:40:33","date_gmt":"2020-01-30T18:40:33","guid":{"rendered":"https:\/\/avalere.com\/?p=18266"},"modified":"2022-07-19T11:23:32","modified_gmt":"2022-07-19T15:23:32","slug":"avalere-statement-on-cmss-healthy-adult-opportunity-program","status":"publish","type":"post","link":"https:\/\/advisory.avalerehealth.com\/insights\/avalere-statement-on-cmss-healthy-adult-opportunity-program","title":{"rendered":"Avalere Statement on CMS\u2019s Healthy Adult Opportunity Program"},"content":{"rendered":"<p>One of the most significant changes is to the way state Medicaid programs can manage prescription drugs. States would be able to develop closed formularies and exclude drugs from coverage, while continuing to receive full manufacturer rebates. Despite protections for certain drugs (e.g., mental health, HIV, opioid use disorder), we expect states could use this flexibility to develop formularies more similar to commercial plans. This is a significant departure from the long-standing policy, which requires states to cover all drugs for which manufacturers pay mandatory rebates.<\/p>\n<p>Outside of changes to the drug benefit, these demonstrations could also allow states to use alternate managed care oversight standards and change other program elements (e.g., provider payment rates).<\/p>\n<p>To receive Avalere updates, <a href=\"https:\/\/info.avalere.com\/LP=46\">connect with us.<\/a><\/p>\n<p>Find out the <a href=\"https:\/\/advisory.avalerehealth.com\/webinars\/avalere-2020-healthcare-industry-outlook-see-the-turns-ahead\">top 2020 healthcare trends to watch.<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>One of the most significant changes is to the way state Medicaid programs can manage prescription drugs. States would be able to develop closed formularies and exclude drugs from coverage, while continuing to receive full manufacturer rebates. Despite protections for certain drugs (e.g., mental health, HIV, opioid use disorder), we expect states could use this&hellip;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[3],"tags":[993],"content-categories":[259],"class_list":["post-18266","post","type-post","status-publish","format-standard","hentry","category-insights","tag-archive","content-categories-policy","entry","no-media"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Avalere Statement on CMS\u2019s Healthy Adult Opportunity Program | Avalere Health Advisory<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/advisory.avalerehealth.com\/insights\/avalere-statement-on-cmss-healthy-adult-opportunity-program\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Avalere Statement on CMS\u2019s Healthy Adult Opportunity Program | Avalere Health Advisory\" \/>\n<meta property=\"og:description\" content=\"One of the most significant changes is to the way state Medicaid programs can manage prescription drugs. States would be able to develop closed formularies and exclude drugs from coverage, while continuing to receive full manufacturer rebates. Despite protections for certain drugs (e.g., mental health, HIV, opioid use disorder), we expect states could use this&hellip;\" \/>\n<meta property=\"og:url\" content=\"https:\/\/advisory.avalerehealth.com\/insights\/avalere-statement-on-cmss-healthy-adult-opportunity-program\" \/>\n<meta property=\"og:site_name\" content=\"Avalere Health Advisory\" \/>\n<meta property=\"article:published_time\" content=\"2020-01-30T18:40:33+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2022-07-19T15:23:32+00:00\" \/>\n<meta name=\"author\" content=\"avalere_wp\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@avalerehealth\" \/>\n<meta name=\"twitter:site\" content=\"@avalerehealth\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"avalere_wp\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"1 minute\" \/>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Avalere Statement on CMS\u2019s Healthy Adult Opportunity Program | Avalere Health Advisory","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/advisory.avalerehealth.com\/insights\/avalere-statement-on-cmss-healthy-adult-opportunity-program","og_locale":"en_US","og_type":"article","og_title":"Avalere Statement on CMS\u2019s Healthy Adult Opportunity Program | Avalere Health Advisory","og_description":"One of the most significant changes is to the way state Medicaid programs can manage prescription drugs. States would be able to develop closed formularies and exclude drugs from coverage, while continuing to receive full manufacturer rebates. Despite protections for certain drugs (e.g., mental health, HIV, opioid use disorder), we expect states could use this&hellip;","og_url":"https:\/\/advisory.avalerehealth.com\/insights\/avalere-statement-on-cmss-healthy-adult-opportunity-program","og_site_name":"Avalere Health Advisory","article_published_time":"2020-01-30T18:40:33+00:00","article_modified_time":"2022-07-19T15:23:32+00:00","author":"avalere_wp","twitter_card":"summary_large_image","twitter_creator":"@avalerehealth","twitter_site":"@avalerehealth","twitter_misc":{"Written by":"avalere_wp","Est. reading time":"1 minute"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/advisory.avalerehealth.com\/insights\/avalere-statement-on-cmss-healthy-adult-opportunity-program#article","isPartOf":{"@id":"https:\/\/advisory.avalerehealth.com\/insights\/avalere-statement-on-cmss-healthy-adult-opportunity-program"},"author":{"name":"avalere_wp","@id":"https:\/\/advisory.avalerehealth.com\/#\/schema\/person\/6cea6678c016753ac38b9aad6cff71aa"},"headline":"Avalere Statement on CMS\u2019s Healthy Adult Opportunity Program","datePublished":"2020-01-30T18:40:33+00:00","dateModified":"2022-07-19T15:23:32+00:00","mainEntityOfPage":{"@id":"https:\/\/advisory.avalerehealth.com\/insights\/avalere-statement-on-cmss-healthy-adult-opportunity-program"},"wordCount":141,"commentCount":0,"publisher":{"@id":"https:\/\/advisory.avalerehealth.com\/#organization"},"keywords":["Archive"],"articleSection":["Insights &amp; 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