Medicare Negotiation
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340B, Caught my eye, Drug Prices, Generics, Inflation Reduction Act, Medicare Negotiation, Medicare Part D, Medicare Transaction FacilitatorCaught my eye — 8/23/24
Read more: Caught my eye — 8/23/24It’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.…
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Biosimilars, Caught my eye, Drug Prices, Employers, Inflation Reduction Act, Medicare Negotiation, Medicare Part D, Pharmacy Benefit ManagersCaught my eye — 8/16/24
Read more: Caught my eye — 8/16/24Just 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…
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The Day has Arrived
Read more: The Day has ArrivedIn my 20s, today would have been like the Super Bowl for nerdiness. I would have been really excited about the first look at the negotiated rates for the first 10 drugs, effective January 2026. But I’m not. Why is my wonkiness holding back? So my hunch is that plans will put the competitor drugs…
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Caught my eye, Inflation Reduction Act, Medicare Negotiation, Medicare Part D, State-based Reform, UncategorizedCaught my eye — 08/02/24
Read more: Caught my eye — 08/02/24Up, up and away. Earlier this week, the Centers for Medicare & Medicaid Services (CMS) announced initial premium information for the 2025 Medicare prescription drug benefit. The base beneficiary premium went up 6% or $2.08 to $36.78. Which sounds okay until you realize that 6% is a capped amount due to the Inflation Reduction Act.…
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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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