Medicare Part D
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Caught my eye — 11/8/24
Read more: Caught my eye — 11/8/24Some days you eat the bear and some days the bear eats you. Looking at Canada? No, not like that. JAMA featured a supply chain shortage look at the U.S. versus Canada. While not all of the lessons from Canada carry over (more flat bureaucracy because of connections between regulators and facilities) – they do…
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340B, Caught my eye, Drug Prices, Inflation Reduction Act, Medicare Negotiation, Medicare Part D, Medicare Transaction Facilitator, Medicare Transaction FacilitatorCaught my eye — 10/18/24
Read more: Caught my eye — 10/18/24Order (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…
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Caught my eye — 10/3/24
Read more: Caught my eye — 10/3/24For 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…
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340B, Caught my eye, Drug Prices, Healthcare Costs, Inflation Reduction Act, Medicare Advantage, Medicare Negotiation, Medicare Part DCaught my eye — 9/20/24
Read more: Caught my eye — 9/20/24Adding 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…
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Caught my eye — 9/13/24
Read more: Caught my eye — 9/13/24On the pile. 46Brooklyn put out a piece demonstrating the difficulty of understanding drug prices. It is a doozy of a read. A set-aside-time-to-concentrate read. But if you are skeptical about drug pricing and want to lump it all on manufacturers, you should take the time to read it. Big picture, there is no single…
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More MP3 Math (3M of M3P)
Read more: More MP3 Math (3M of M3P)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…
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MP3 Take 2
Read more: MP3 Take 2For 2024, the Medicare prescription benefit (Part D) has implemented an out-of-pocket cap (OOP) for beneficiaries. Once they spend $8,000, they have $0 cost sharing. For patients on branded medicines, this can bring the total annual OOP to about $3,300. But in 2025, the Part D redesign (courtesy of the Inflation Reduction Act) gets much…
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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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Caught my eye — 8/9/24
Read more: Caught my eye — 8/9/24A pretty quiet week for pharma health policy but there are a few things I think you should know … The Auchincloss Venn Diagram. Brian Reid improved upon Congressman Auchincloss’s diagram and I think it provides a great way to think about pharmacy benefit manager (PBM) reform. No chicken, no egg – straight to the…
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