AMP is WAC (and other thoughts)
Latest posts and updates
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 — 12/8/23
Read more: Caught my eye — 12/8/23Marching right past. Senator Bernie Sanders held up the head of the NIH hearings because he wanted to make sure march-in rights were part of the policy conversations on drug pricing. I can’t decide if march-in rights are like your 1st grade teacher asking for part of your salary because she was part of your…
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Striving toward equity in IRA negotiations
Read more: Striving toward equity in IRA negotiationsThis morning I attended the Innovation and Value Initiative’s (IVI’s) event on “Ensuring Equity in Implementation of IRA Drug Price Negotiations.” As the discussions went on, I began to believe that ensuring equity in the Inflation Reduction Act (IRA) negotiation process was too herculean. To ensure equity would require… So maybe the title of the…
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Caught my eye — 12/1/23
Read more: Caught my eye — 12/1/23Patient no more. A few weeks ago I wrote about how thanks to the HIV Hepatitis Policy Institute, the Diabetes Leadership Council and the Diabetes Patient Advocacy Coalition and their suit against the Department of Health and Human Services, accumulator programs were dealt a blow. They can only be used if it is for a branded…
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Saying bye to the donut hole
Read more: Saying bye to the donut holeBack on November 17, the Centers for Medicare & Medicaid Services (CMS) released a slew of policy on the Medicare prescription drug benefit transition to the Medicare manufacturer discount program. This is the program that will be replacing the Coverage Gap discount program as of January 2025. The big document was the Part D Manufacturer…
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Caught my eye — 11/17/23
Read more: Caught my eye — 11/17/23For the policy wonk that has everything. I give you the 2025 Notice of Benefit and Payment Parameters. Everything you wanted to know about DIR but were afraid to ask. Direct remuneration (DIR) doesn’t exactly roll off the tongue but it is a big part of the behind the scenes reimbursement of pharmacies. DIR are…
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Orphan drug: Expand the label and you lose
Read more: Orphan drug: Expand the label and you loseFrom a patient perspective, the Inflation Reduction Act (IRA) definitely has some upside. Starting in 2024, the out-of-pocket cap in the Medicare prescription drug benefit starting is fantastic for beneficiaries taking more expensive products. Although this is a minority of patients, it still gives piece of mind to many knowing that if they find themselves…
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Caught my eye — 11/10/23
Read more: Caught my eye — 11/10/23Guess which one costs more. This Wall Street Journal article has been making the rounds this week. It highlights how if there are two prices for a drug, plans tend to prefer the higher cost one with higher rebates. I hesitate to call it news because it seems so obvious to those of us who…
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Same Same Was Different : Proposed Biosimilar Interchangeability Flip
Read more: Same Same Was Different : Proposed Biosimilar Interchangeability FlipLast year CMS proposed regulations allowing for Part D sponsors to remove a reference product from a formulary and immediately substitute it with an interchangeable biologic or an unbranded biologic product approved under the same biological license application. In the final rule, they pulled back and said they would not finalize the proposal until at…
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Caught my eye — 11/3/23
Read more: Caught my eye — 11/3/23InNOvation. Seagen said they aren’t looking at a drug that would treat early-stage bladder cancer because it would be subject to negotiation too soon after approval and wouldn’t have a financial return on the investment. Today the National Pharmaceutical Council published a great piece in Health Affairs that goes deeper into the subject of innovation…
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Part D: Hope on the horizon (Part IV)
Read more: Part D: Hope on the horizon (Part IV)The Medicare negotiation patient listening sessions are being held this week; many of the patients are talking about affordability challenges and the need to switch medicines/treatments because of cost. Some of the patients said they are looking forward to the negotiation so they can have lower cost sharing. To me, this demonstrates the need to…
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