AMP is WAC (and other thoughts)
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ABOUT AMP is WAC
Average Manufacturer Price (AMP) is not equal to Wholesale Acquisition Cost (WAC), but it is close. And since the whole world of health policy and reimbursement is a bit WAC-y, that’s what we’re calling this update/blog part of the site. All of the opinions and thoughts presented here are our own and not the views of clients or affiliates.
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Caught my eye — 4/26/24
Read more: Caught my eye — 4/26/24What the math. Yesterday afternoon CMS released a technical memo on the changes to True Out-of-Pocket (TrOOP) Costs and the maximum monthly cap for the Medicare prescription payment plan (MP3.) Simply put, they put out a memo that shows the math for the smoothing program. I need to work through some of the examples because,…
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Why high price, high rebates will continue to win
Read more: Why high price, high rebates will continue to winUpdated 8/8/24. I live in a headspace that assumes everyone is up to date on the nuances of things and that I don’t need to write about it because it’s old news. And then I read this article in the Pink Sheet on how Medicare-negotiated prices may not get favorable coverage and realized that nope,…
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Caught my eye — 4/19/24
Read more: Caught my eye — 4/19/24Just… wow. Healthcare has a lot of rabbit holes but as the head of the Department of Health and Human Services, copay accumulators should be understood at a basic level. I’m not asking about alternative funding and to draw up a case study. Just that accumulators can’t be used in Medicare. Basics. Heck a simple…
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Return of the MAC (Well I tried to tell you so)
Read more: Return of the MAC (Well I tried to tell you so)Last week MedPAC, the Medicare advisory committee to Congress, had a really interesting session on generic drug pricing in the Medicare prescription drug program (Part D.) There is always so much focus on branded drugs that an opportunity to flip the script and learn about the 90% of prescription drug utilization in Part D (and…
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Affordable Care Act, Healthcare Costs, ICER, Inflation Reduction Act, Medicare Advantage, Medicare Negotiation, Medicare Part D, State-based ReformCaught my eye — 4/12/24
Read more: Caught my eye — 4/12/24PDAB-adieu. This week Governor Youngkin vetoed a bill that would have established a prescription drug affordability board (PDAB) in the state. The PDAB would have had authority over state-sponsored and state-regulated health plans. Younkin said that the PDAB would have determined drug availability solely on cost rather than unique patient needs and the opinions of…
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Talking a big game, the Rx is in the mail
Read more: Talking a big game, the Rx is in the mailConfession. I think Mark Cuban’s Cost Plus Drugs is underwhelming at best and, at worst, the death of independent pharmacies. I’ve been following it since inception, and I just can’t get excited about it – at least not yet. Cost Plus Drugs dispenses about 3,000 generic drugs. There is the transparent price, a 15% markup,…
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Biosimilars, Caught my eye, CMMI, Drug Prices, Drug shortages, Health Equity, Inflation Reduction Act, Medicare Part D, ObesityCaught my eye — 4/5/24
Read more: Caught my eye — 4/5/24Ruling It. Yesterday afternoon, the Centers for Medicare & Medicaid Services released the MA/Part D final rule. Personally, most of it was not up my alley but I did read over the changes to the changes to an approved formulary sections. In December 2022, CMS proposed allowing immediate substitution of interchangeable biosimilars or branded biologics…
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Part D Policy: Reading it so you don’t have to
Read more: Part D Policy: Reading it so you don’t have toLate Monday, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2025 Rate Announcement for Medicare Advantage and the Medicare Prescription Drug Program (Part D) as well as the CY25 Part D Redesign Program Instructions. I was about to get on an airplane and instead of watching a movie, I figured what sounds like a…
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Caught my eye — 3/29/24
Read more: Caught my eye — 3/29/24It has been a week of odds and ends so if you’re catching up after ignoring your emails, you didn’t miss a ton. Honestly, it seems like a good time to be a DC law firm working on pharmaceutical issues. You have the usual Inflation Reduction Act submissions, comment letters (which, for what it is…
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340B, Replenish and Repeat
Read more: 340B, Replenish and RepeatI’m out and about this week so I’m reposting a piece I wrote last year…. If you missed it, I wrote about 340B basics. Here is a quick summary: There are hospitals, clinics, etc. that serve uninsured individuals. To help care for these patients, the 340B program requires pharmaceutical manufacturers (that wish to participate in…
Latest news
- AMP is WAC — 04/24/26
- AMP is WAC — 04/10/26
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- AMP is WAC — 03/20/26
- AMP is WAC — 03/13/26
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