It took my until 5 pm on Thursday to figure out why there was a frog on the Microsoft tool bar. Leap year. Frog. Leap. Sigh. I prefer not. Congress seems to have hit the pause button (at least temporarily) on pharmacy benefit manager (PBM) reform. And that sort of felt okay because, realistically, things…
Gross to Net, a Saga. As soon as I saw Adam Fein’s Drug Channels article on Gross to Net in Part D redesign, I knew it would throw off my day. It was just catchy enough to cause a buzz and get the attention of Heads of Market Access at pharmaceutical companies and start the…
This afternoon I’m giving a talk to a group of patient advocates on the Medicare prescription drug benefit (Part D). As I prepared, I was struck by the fact that this is one of the few times that I feel that I’m (mostly) giving out good policy news. Are there downsides to the Medicare Part…
A whirlwind of a week. I regrouped on Wednesday and got a run in and some pottery wheel time and then it all fell apart again (in a good way) on Thursday where I forgot to leave my desk for hours and hours. One of those “I love working” and forget time exists. So much…
We’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…
Yesterday, 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…
Back 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…
For the policy wonk that has everything. I give you the 2025 Notice of Benefit and Payment Parameters. Everything you wanted to know about DIR but were afraid to ask. Direct remuneration (DIR) doesn’t exactly roll off the tongue but it is a big part of the behind the scenes reimbursement of pharmacies. DIR are…
Last year CMS proposed regulations allowing for Part D sponsors to remove a reference product from a formulary and immediately substitute it with an interchangeable biologic or an unbranded biologic product approved under the same biological license application. In the final rule, they pulled back and said they would not finalize the proposal until at…
InNOvation. 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…