Margaret Scott

Margaret Scott supports clients with Medicaid drug policy and pricing.

She applies her extensive background in Medicaid drug policy and pharmacy benefits management to guide policy advocacy and market strategy for drug companies, health plans, patient groups, and other stakeholders.

Prior to joining Avalere, Margaret led the pharmacy program for Ohio Medicaid, where she oversaw all aspects of pharmacy policy and operations, including implementing federal and state policy, ensuring Medicaid-contracted managed care organizations were following state and federal policies, supervising drug rebate collections, coordinating the pharmacy and therapeutics committee and drug utilization review board, and directing drug pricing. Margaret also spent time as a clinical adviser at CVS Caremark, where she advised Medicaid managed care organization clients on pharmacy benefits management topics including claims processing, formulary development, utilization management, and compliance with federal and state Medicaid requirements.

Margaret has a BS in pharmacy from Purdue University, an MS in pharmacy administration concentrating in health outcomes research from the Ohio State University, and an MPH in health systems management and policy from the Ohio State University.

Authored Content

Compared to other drivers of state budget pressures during the COVID-19 pandemic—including higher Medicaid program enrollment due to increased unemployment and lower state tax revenues as a result of economic shutdowns—the relative financial impact of COVID-19 therapeutics on state Medicaid budgets will likely be minimal.

Medicaid will continue to experience considerable changes at the state and federal levels, both in terms of beneficiary demographics and the payer landscape. Stakeholders should consider how upcoming elections, policy proposals, and COVID-19 will impact benefits and payer dynamics.

The CMS proposes to define line extension under the MDRP to broadly include any product that has at least one ingredient in common with the original drug, even if it is a different dosage form. If finalized, this change would have significant implications on classification and rebate liability for a wide set of current and future products.

After adjourning or suspending sessions due to the COVID-19 pandemic, state legislatures are reconvening with new priorities, as pandemic-related policy decisions take precedence.

CMS proposes to alleviate drug price reporting barriers that have hindered the adoption of innovative contracting models for prescription drugs. Stakeholders should contemplate the details and implications of CMS’ proposals—including how the changes would impact current contracting—as well as remaining areas of ambiguity.

As COVID-19 forces the healthcare system to reprioritize patients and resources, providers delivering behavioral health services may be left with insufficient means to serve the population. Medicaid programs may observe increased demand for behavioral health services but may be ill-equipped to support beneficiaries.

1115 Waivers approved by CMS allow state Medicaid programs to better address substance use disorders among beneficiaries.

As control of the Medicaid drug benefit continues to shift from managed care organizations to states, manufacturers should understand unique benefit dynamics in each state, particularly as Medicaid enrollment is likely to increase amid the COVID-19 pandemic.

State Medicaid programs face a series of near- and long-term challenges amid the COVID-19 pandemic due to enrollment growth and financial pressures. Stakeholders should evaluate key drivers shaping the state-by-state Medicaid outlook.

On February 27, Avalere experts discussed the latest policy, pricing, and reimbursement challenges for prescription drugs in Medicaid in the “What’s Next for Medicaid Drug Pricing?” webinar. They reviewed the ways prescription drugs are managed in Medicaid, what innovative medicines may mean for the program, and potential implications of CMS’ Healthy Adult Opportunity (HAO).

View the webinar recording to learn more about the latest policy, pricing, and reimbursement challenges in Medicaid.

The Centers for Medicare & Medicaid Services (CMS) announced the Healthy Adult Opportunity, a new Section 1115 demonstration initiative allowing states to shift toward capped Medicaid financing models with an opportunity for shared savings. If the option is chosen by states, it could be the largest change to Medicaid since the ACA.

CMS’s Healthy Adult Opportunity program, a new Section 1115 demonstration initiative, will allow state Medicaid programs to move toward capped financing models for some non-disabled adult beneficiaries with an opportunity for shared savings and additional flexibilities.