As we look ahead to next week and Thanksgiving, I have to say thank you to you for subscribing and reading. I got the stuffing knocked out of me this summer but knowing that this group of subscribers hangs in there and continues to read is nice. As I look ahead to the next year,…
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…
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…
Not everything can be important, or nothing is. It’s the time of year when white boards and Post-It easels come out and prioritization for 2025 gets reviewed. From a consultant perspective, I love these exercises. It allows for a look at what needs direct action, coalition or monitoring. And the $ has to go to…
For most drugs, it is not IF but WHEN they will be negotiated by Medicare so if you thought you could ignore guidance coming out this week, you were wrong. Everyone on the pharma side needs to be thinking of how the Inflation Reduction Act impacts them, even if you’re early on in the pipeline…
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…
As I wrote about previously, in 2025, the Medicare prescription drug benefit (Part D) gets a $2,000 out-of-pocket (OOP) cap for beneficiaries and the ability to “smooth” the cost sharing over the course of the year. This program is called the Medicare Prescription Payment Plan (M3P). Last week I created slides showing the month expenditures…
The slight panic of 4 months left in the year is starting to hit but the amazing weather in the D.C. area made it seem just a bit less urgent. If you need any help with policy work these next few months or filling a speaking gig, I’m here for it. MedPAC was back this…
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.…
Just a quiet health policy week. Well actually, depending on your level of wonkiness, it kind of was? But let’s get into what you need to know. They’re Here! On Thursday, the Centers for Medicare & Medicaid Services released the “negotiated” prices for the initial ten Medicare prescription drug benefit drugs (Part D); these prices…