State-based Reform
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Caught my eye — 10/25/24
Read more: Caught my eye — 10/25/24Caught my eye .. This week I am struck by connections between 340B and pharmacy benefit managers (PBMs) in terms of being issue areas that need complete makeovers. A glow up won’t do; we’re beyond that. But the trajectory toward change is very different. PBMs and payers (maybe) benefit from the way PBMs currently work.…
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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 — 6/14/24
Read more: Caught my eye — 6/14/24Summer vibes are real in the DC area this week with schools letting out and pool time kicking in. College wood bat baseball league games are on, and the summer night hang out is in full swing. I don’t know if it is my mood or the season or both, but things seem a little…
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Caught my eye — 06/07/24
Read more: Caught my eye — 06/07/24A relatively quiet week around these parts. I think everyone is so ASCO’d and BIO’d that policy is taking a quick breather. A PDAB will do you. The National Pharmaceutical Council put out a nice round-up comparing four prescription drug affordability boards. The chart is my favorite part – Extra, extra. Elevance Health, a health…
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Getting nowhere fast
Read more: Getting nowhere fastMy mom said to never use the word hate but, honestly, I hate step therapy. I dislike prior authorization but step therapy, well I hate it. Both fall under the concept of utilization management which are barriers to access put up by payers (really pharmacy benefit managers (PBMs)) for cost or safety concerns. The idea…
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340B, Caught my eye, Drug Prices, Inflation Reduction Act, Medicare Negotiation, Pharmacy Benefit Managers, State-based ReformCaught my eye — 05/24/24
Read more: Caught my eye — 05/24/24Coulda, woulda, shoulda. On Tuesday, the Senate Judiciary committee had a hearing on prescription drug prices. It became clear that comparisons to international prices remain a focus but so is patent abuse. I am not sure that’s a fair characterization. What companies are doing is legal and I’m not sure they’d be doing their fiduciary…
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Affordable Care Act, Healthcare Costs, ICER, Inflation Reduction Act, Medicare Advantage, Medicare Negotiation, Medicare Part D, State-based ReformCaught my eye — 4/12/24
Read more: Caught my eye — 4/12/24PDAB-adieu. This week Governor Youngkin vetoed a bill that would have established a prescription drug affordability board (PDAB) in the state. The PDAB would have had authority over state-sponsored and state-regulated health plans. Younkin said that the PDAB would have determined drug availability solely on cost rather than unique patient needs and the opinions of…
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Caught my eye — 3/29/24
Read more: Caught my eye — 3/29/24It has been a week of odds and ends so if you’re catching up after ignoring your emails, you didn’t miss a ton. Honestly, it seems like a good time to be a DC law firm working on pharmaceutical issues. You have the usual Inflation Reduction Act submissions, comment letters (which, for what it is…
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340B, Biosimilars, Caught my eye, Employers, Importation, Obesity, Pharmacy Benefit Managers, State-based ReformCaught my eye — 03/15/24
Read more: Caught my eye — 03/15/24It was one of those rare weeks in Washington, DC where the weather was just perfect. I mean not if you suffer from allergies, but for everyone else. Same Same. Last week we had the State of the Union, this week we had the President’s Budget release. For what it is worth, the budget is…
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Caught my eye — 2/23/24
Read more: Caught my eye — 2/23/24Gross 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…
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