Medicare Part D
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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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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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Caught my eye — 11/17/23
Read more: Caught my eye — 11/17/23For 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…
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Same Same Was Different : Proposed Biosimilar Interchangeability Flip
Read more: Same Same Was Different : Proposed Biosimilar Interchangeability FlipLast 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…
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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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Part D: Hope on the horizon (Part IV)
Read more: Part D: Hope on the horizon (Part IV)The Medicare negotiation patient listening sessions are being held this week; many of the patients are talking about affordability challenges and the need to switch medicines/treatments because of cost. Some of the patients said they are looking forward to the negotiation so they can have lower cost sharing. To me, this demonstrates the need to…
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Prediction: MA is the new PBM (Part D, III)
Read more: Prediction: MA is the new PBM (Part D, III)I’d like to make a prediction. The next big political focus (after PBMs, if we give up on PBMs?) is going to Medicare Advantage. There is a lot of money flowing through managed care and scrutiny feels inevitable. It is just that if you’re following the dollar, a lot is going that way. A few…
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Caught my eye — 10/20/23
Read more: Caught my eye — 10/20/23Want a friend, get a cat. A doctor prescribes a cat for a patient. I question the out-of-pocket costs of the Rx, but point taken. Speaking of PETS. A few Alzheimer’s updates – Déjà vu. The Part B premiums increased in 2024 due to newly approved Alzheimer’s treatments. It wasn’t noted in the fact sheet…
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They don’t build them like they used to. For Part D, it’s better (Part 2)
Read more: They don’t build them like they used to. For Part D, it’s better (Part 2)Recently my treadmill became a paperweight. The technician came out and said that it would be better to buy the parts and fix it because the new ones were just not made as well as my old one. A refrain I’ve heard over the years as it relates to heating units, refrigerators, etc. But Part…
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Part D Evolution, Part 1: Enrollment
Read more: Part D Evolution, Part 1: EnrollmentThis time of year brings on a sense of nostalgia for me related to the Medicare prescription drug benefit (Part D). Back in 2005, I had just started working at Avalere and we got our first data on what plans were offering for the inaugural year of the benefit. I remember launching into the file…
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