Inflation Reduction Act
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340B, Biosimilars, Copay Accumulators, ICER, Inflation Reduction Act, Medicare Negotiation, Medicare Part D, Pharmacy Benefit ManagersNot on my 2023 Bingo Card
Read more: Not on my 2023 Bingo CardWe’re in that last work week before everyone dashes off. My own clients have headed for the hills (Short Hills?) and I’ve been baking and wrapping this week. It makes me appreciate the usual day to day of policy and reimbursement more than I would have thought. Next week I’ll pull out the vision boards…
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Caught my eye, Healthcare Costs, Inflation Reduction Act, Medicare Negotiation, Pharmacy Benefit ManagersCaught my eye — 12/15/23
Read more: Caught my eye — 12/15/23Driving home (the message.) Yesterday President Biden drove up to the National Institutes of Health and gave a speech about drug prices. My main issue with it is the traffic caused by shutting down the beltway and all the roads around my neighborhood. Okay and I think that a lot of the inflation penalties for…
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Catastrophic Communications
Read more: Catastrophic CommunicationsYesterday, the Kaiser Family Foundation released survey results that showed that only 25% of adults over 65 knew about the Medicare prescription drug benefit (Part D) out-of-pocket cap starting in January 2024. Coincidentally, I also spent a chunk of yesterday explaining the $0 patient cost-sharing in catastrophic to two different groups yesterday. Both of whom…
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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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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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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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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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Caught my eye — 10/6/23
Read more: Caught my eye — 10/6/23Patients driving change. I love this story because it involves Carl Schmid, patient groups and copay accumulators. Copay accumulators are when insurance does not allow pharmaceutical manufacturer contributions to count towards patient out-of-pocket spending calculations. Thanks to the HIV+Hepatitis Policy Institute, the Diabetes Leadership Council and the Diabetes Patient Advocacy Coalition and their suit against…
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Caught my eye — 9/29/23
Read more: Caught my eye — 9/29/23It’s not a vacation. Let’s start with federal employees; you deserve better. You often could get paid more elsewhere but you want to serve. And instead of saying thank you, Congress asks you to take a seat on the bench and (hopefully) get backpay. It feels awful and I am so sorry you have to…
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