Medicare Part D
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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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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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Caught my eye — 07/26/24
Read more: Caught my eye — 07/26/24Let’s be honest, health policy has sort of taken a backseat when it comes to what we’re all tracking these days. And that’s okay. If you’ve taken a deserved timeout, let me catch you up on what caught my eye. Ice Ice Baby. The House of Representatives Committee on Oversight and Accountability released a report…
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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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340B, Biosimilars, Drug Prices, Generics, Healthcare Costs, Medicare Advantage, Medicare Part D, ValueCaught my eye — 6/21/24
Read more: Caught my eye — 6/21/24You know it is hot when I say, “Let’s go for a walk” and my dog looks at me from the stop of the stairs and refuses to move. At 6:30 in the morning. I hope you’re feeling more motivated than he is. Same same, not different. Late last year, the Medicare prescription drug benefit…
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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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