@Amanda Well, it's a joint Federal/ States program. The states actually run it by subcontracting it to private insurance companies (classic neoliberalism).
It has been my understanding that Medicare and Medicaid, are under the same bureaucratic Federal umbrella (there's a name for that agency).
Any negotiation on price is truly piecemeal and kind of a joke compared to what real negotiation across the board would be.
Florida's Medicaid program pays 100% retail for drugs, but only offers generic, and denies authorization for some (many?) drugs.
The elephant (sic) in the room is that drug companies were exempted from Federal anti-trust law in the '40's and nothing has been done about it.
There are huge disadvantages to Medicaid in Florida. PCPs have a heavy disincentive to make specialist recommendations. You'd practically have to fall down in front of a PCP and break an arm or a leg to get one.
Florida pays for Medicaid prescriptions on the assumption that almost all Medicaid receipts have literally no money.
Of course, we'll have to see, if we live long enough, what effects Trump cutting almost $1 trillion from Medicare, Medicaid, and the ACA will have in the immediate and long term.
I think it's a two party set up (I'm cynical that way) but I confess Trump II has been a wrecking ball the likes of which I did not predict.
