MM Curator summary
[MM Curator Summary]: While the OR waiver request contains many new features, a closed drug formulary will not be one of them.
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In response to a raft of concerns, Oregon has withdrawn a request made to federal officials to restrict medicines covered by the state Medicaid program, which is currently required to provide coverage for all treatments. However, state officials are still seeking to exclude certain drugs from Medicaid when effectiveness evidence is lacking.
By seeking a so-called closed formulary, the same approach to coverage taken by private health insurers, Oregon officials had hoped to lower expenses by only covering one drug for each therapeutic class. So far, though, only Tennessee has been granted a waiver to use a closed Medicaid formulary and the Biden administration is reviewing that decision, which was issued by the Trump administration.
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