Broken Crystal Ball. Does the knowledge that RFK Jr might be heading up the Department of Health and Human Services get me any closer to guessing what might happen in the next 2 – 3 years for pharmaceutical health policy? Nope. But it wouldn’t seem like it would be good for innovation. NIH grants? Developing…
Caught my eye .. This week I am struck by connections between 340B and pharmacy benefit managers (PBMs) in terms of being issue areas that need complete makeovers. A glow up won’t do; we’re beyond that. But the trajectory toward change is very different. PBMs and payers (maybe) benefit from the way PBMs currently work.…
Order (Not) Ready. The National Community Pharmacists Association surveyed just under 500 independent pharmacy owners and the results are really interesting. Almost ¾ had not signed 2025 Part D pharmacy contracts as of about a month ago. Of those that dispense GLP-1 agonists, 96% lose money on them; it makes sense why 59% are thinking…
Adding On. So glad to see this research from Avalere conducted on behalf of the Community Oncology Alliance (COA) on the impact of the Inflation Reduction Act (IRA) negotiation on Medicare Part B provider reimbursement. While in Medicare Part D, negotiated prices do not factor into Average Manufacturer Price, the legislation is silent on whether…
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.…
You know it is hot when I say, “Let’s go for a walk” and my dog looks at me from the stop of the stairs and refuses to move. At 6:30 in the morning. I hope you’re feeling more motivated than he is. Same same, not different. Late last year, the Medicare prescription drug benefit…
Trying to change my view. I don’t know if it is summer malaise setting in or an existential crisis about the state of society, sometimes it is hard to tell. Earlier this week, Jessica Yellin of News Not Noise pointed out that a lot of articles are really negatively titled and it is driving a…
Coulda, woulda, shoulda. On Tuesday, the Senate Judiciary committee had a hearing on prescription drug prices. It became clear that comparisons to international prices remain a focus but so is patent abuse. I am not sure that’s a fair characterization. What companies are doing is legal and I’m not sure they’d be doing their fiduciary…
Recently RAND put out a study about prices paid to hospitals by private payers. Right in the summary is a statistic that made me pause – commercial insurance prices for administered drugs received in a hospital setting averaged 278 percent of average sales price (ASP) compared with 106% of ASP paid by Medicare for administered…
When I first got into this pharmaceutical health policy and reimbursement world in 2005, I mostly ignored 340B. It was a big discount that was required, and you couldn’t do anything about it, so it just was. Then maybe 2012 or so I remember Andy Swire from Amgen was super amped up about 340B…