Last Saturday I was in the customs line in Amsterdam and the agent smirked and said, “Big Beautiful Bill, huh?” I wanted to say something, but I was mostly impressed that he was following U.S. news more closely than a lot of Americans.
Caught my Eye
340No. IQVIA released a study looking at the use of 340B discount cards used to share 340B discounts with patients. It found that less than 5% of 340B branded prescriptions at contract pharmacies used a 340B card. Different covered entities had different rates of utilization; disproportionate share hospitals have about 75% of 340B drug utilization but only about 43% of 340B drug card use.
OBBB. The One Big Beautiful Bill passed and the Medicaid impact is troubling. If you want to dig in, I found this KFF resource helpful. One of my concerns is that people don’t even know that they are on Medicaid because it is called so many different things. And here is why I don’t like work requirements. Removing fraud is a good goal but my concern is all of the eligible people who get caught in the process and don’t know that they need to fill out paperwork or miss deadlines, etc. John Oliver covered it well.
OGT. One Good Thing. The orphan drug provision in the OBBB was a spot of joy. It allows a drug to have multiple orphan designations and not be part of Medicare negotiation. If a drug has a broader indication, the negotiation clock starts with the broader indication.
No Parking, No Space and Legionnaire’s. Two articles (Stat News and NYT (gifted)) highlighted the problems this spring at the Food and Drug Administration and ponder the long-term impact.
Same Same but Different. I’m know I was supposed to take away something different from this article, but I got focused on the fact that 9% of United Kingdom’s National Health Service budget goes to medicine compared to 17% in Germany and Italy and 15% in France. The U.S. often thinks it spends too much on drugs – but it could be that all healthcare is more here because, as a %, we are right in line.
Reviewing the Fundamentals – Medicaid Cost Sharing for Rx
The One Big Beautiful Bill will require states to impose cost-sharing of up to $35 per service for adults enrolled through the Medicaid expansion with incomes between 100% and 138% of the FPL. This change is effective starting October 1, 2028. However, this specific provision states that prescription drugs are exempt from change.
Under current Medicaid rules, cost-sharing for prescription drugs is typically kept at “nominal” levels. The maximum allowable copayments for drugs vary based on income and drug type:
- For individuals with family income at or below 150% of the Federal Poverty Level (FPL):
- Preferred drugs: Up to $4 per prescription.
- Non-preferred drugs: Up to $8 per prescription.
- For individuals with family income above 150% of the FPL:
- Preferred drugs: Up to $4 per prescription.
- Non-preferred drugs: Up to 20% of the cost the state Medicaid agency pays for the drug.
It’s important to note that these are maximums, and many states currently charge less or exempt certain groups. Additionally, total out-of-pocket costs for a family in Medicaid are capped at no more than 5% of their family income. Certain groups are also generally exempt from most cost-sharing, including children, pregnant women, and individuals residing in an institution.
In case you were wondering, 150% of the FPL for 2025 for a family of 4 is $48,225.
For the Files
Oh… state fact sheets on 340B, yes please.
