Medicare Negotiation
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When Less is More (in a not good way)
Read more: When Less is More (in a not good way)According to the June 2024 analysis by Milliman for the Pharmaceutical Research and Manufacturers of America (PhRMA), the Inflation Reduction Act’s (IRA) drug pricing provisions could increase out-of-pocket (OOP) costs for 3.5 million Medicare Part D patients in 2026. The analysis estimates that beneficiaries who take medicines subject to the Medicare Drug Price Negotiation Program (MDPNP) could…
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Caught my eye — 05/31/24
Read more: Caught my eye — 05/31/24Trying 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…
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No Time for Patience
Read more: No Time for PatienceToday I’m doing a presentation for patient advocates on the Initial Price Applicability Year (IPAY) Guidance 2027 that the Centers for Medicare & Medicaid Services put out a few weeks ago. I thought you might enjoy the overview as well. Long story short – the guidance is focused on the Medicare negotiation process for 2027.…
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340B, Caught my eye, Drug Prices, Inflation Reduction Act, Medicare Negotiation, Pharmacy Benefit Managers, State-based ReformCaught my eye — 05/24/24
Read more: Caught my eye — 05/24/24Coulda, 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…
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Part B, ASP and 340B
Read more: Part B, ASP and 340BRecently 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…
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Caught my eye — 5/17/24
Read more: Caught my eye — 5/17/24Crab cakes and … horse racing. That’s what Maryland does. Mine will come with a side of Smith Island cake which I’m making tomorrow morning. Wish me luck. Odds aren’t stacked. The Centers for Medicare & Medicaid Services (CMS) announced that the Medicaid rule won’t contain the stacking provision. A little odd to pre-announce it,…
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340B, Caught my eye, Drug Prices, Employers, Healthcare Costs, ICER, Inflation Reduction Act, Medicare Negotiation, Medicare Part D, Medicare Transaction Facilitator, Reference Pricing, ValueCaught my eye — 5/10/24
Read more: Caught my eye — 5/10/24Back to back. Arnold Ventures put out the latest anti-pharma talking points (h/t Brian Reid) and here were two back to back – Here’s the problem, it really isn’t about the cost of drugs. I mean you could take that drug price and reduce it 98% and the 25% cost share would still be too…
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Could have used the Easy Button
Read more: Could have used the Easy ButtonThe Inflation Reduction Act (IRA) is a little fuzzy on the details of how Medicare negotiated prices get into the system. It says that pharmacies need to be able to purchase at this price but is silent about the mechanics. This stuff is hard. But gosh sometimes I feel like the implementation could be so…
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Caught my eye — 5/3/24
Read more: Caught my eye — 5/3/24LDT. Not a sandwich, not a drink but laboratory developed tests. On Monday, the Food and Drug Administration (FDA) put out the long anticipated final rule on LDTs. If you’re more of a prescription drug policy person, get used to following LDT policy. We’ve moved from tests that are nice but, even if you have…
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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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