It’s an Inflation Reduction Act (IRA) hangover kind of week. Last week the first Medicare negotiated prices for 2026 were announced and this week is the “what does this mean?” week with everyone catching up and chiming in. What I wrote last week stands but if you want another review, Health Affairs/KFF has you covered.
Two-for-340B. The next concern for the negotiated prices is how to implement them and something I’ve worried a lot about negotiated drugs and how they work with 340B. The IRA says that manufacturers have to provide either the 340B discount or the negotiated rate, whichever is lower. The Centers for Medicare & Medicaid Services (CMS) has bowed out of the process and refused to ensure that there is no duplication. Go figure it out is an unhelpful tact to take with entities that don’t traditionally work all that well together on this issue (manufacturers and 340B entities.) Late last month the Pink Sheet wrote about this issue if you want to dig in.
Check out this factoid: % of claims filled in 340B pharmacies for the negotiated drugs include 47% for Eliquis, 48% for Januvia, 48% for Xarelto and 74% for Imbruvica
I was reminded of this piece when I saw 340B Report article highlighted by Adam Fein saying that four out of the 10 negotiated drugs will have prices that are below the 340B price. Honestly, I’m a little surprised. These are mostly drugs that highly negotiated so for the negotiated rate to be below 340B seems odd. Unless they just aren’t negotiated this low. You’d think this would be great news for the 340B entities – lower prices! – but not really. For those drugs there will be no margin in Medicare. A good deal for the federal government, less so for the entities.
Bookmark. Sometimes get copay accumulators, maximizers and alternative funding programs confused? You’re not the only one. Download this Journal of Managed Care Pharmacy article or save it as a bookmark. Nice graphic, good case studies to review.
On the pile. The weather here in DC has been amazing this week so these went on the pile to read when I’m not trying to enjoy the reprieve from humidity:
What comes up. JAMA has an article looking at drug pricing in 8 countries pre and post patent expiration. The United States prices fall fast and hard. Which is good for us but we also had the furthest to fall. Important to acknowledge and then we can argue about the trade-offs
Spiral of doom? Health Affairs Forefront covered the Part D premium issue for standalone prescription drug plans thinking about low income subsidy plans (LIS). I still plan on (eventually) writing a post on premiums but important to highlight that even 2024 was not great for LIS plan choice.