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 move slowly and we were waiting for the Federal Trade Commission to say something about PBMs. Back in 2022 they demanded answers from PBMs and it turns out they were ignored. Or, as the letter to Congress says, “The respondents have proceeded with varying levels of speed in their productions and compliance with the Orders.”
I think it is the first-born child in me that questions – can you do that? Can you just ignore a request like that? I mean not really because the FTC can take this to the courts but that means you kind of can ignore stuff and hope that people forget. For what it is worth, no one seems to be forgetting PBM reform anytime soon.
If there is a listening session on PBMs and Marc Cuban isn’t there, did it even happen? The savings shown are often a huge exaggeration and generics are a buffer for pharmacies and wholesalers to make money when branded drugs run on narrower margins but the one thing I do like about his venture is that it is flat-fee not % based. On Monday, the White House is reportedly doing a listening session on PBMs. I really hope someone brings up copay accumulators. A girl can dream.
And while on the topic. I stumbled upon this piece on why PBM rebates should be banned.
Smooth Operator. Late yesterday the Centers for Medicare & Medicaid Services issued the final Medicare Prescription Payment Plan (MPPP) (or smoothing) guidance for Part 1. Two sentences caught my attention “CMS has revised section 60.2.3 to state that Part D sponsors and pharmacies must use a $600, single prescription POS threshold to identify enrollees likely to benefit. CMS chose a single prescription drug cost POS threshold of $600 because this approach identifies Part D enrollees with a very high likelihood (~98%) of benefiting from the Medicare Prescription Payment Plan program, while reducing the risk of identifying Part D enrollees for whom the program may not be as helpful.”
In case you’re wondering, that may confuse beneficiaries because they will have met their cap but still face high cost-sharing the next month because of the rollover from previous months.
State by State. The AIDS Institute released a report looking at copay accumulator adjustment policies with a grade for each state.
Delivering Care. When my mom was ill, I resorted to occasionally DoorDashing Panera to her because I lived 2 hours away and wanted to make sure that she had food to eat that was relatively healthy and she liked. Something more motivating to eat than what she might be able to make herself given her circumstances. Turns out food as medicine in Medicare is getting a shove from Congress and might be able to be done without legislation. Likelihood? Probably not high but put it on the parking lot of ideas that maybe one day get runway.
Scanning the horizon. I always like it when I see one of the “what to watch” articles. They seldom are surprising but that makes me feel better. Sure, we could ALL be missing the big thing that could happen, but it reassures me I’m tracking the right stuff. So, the BIO panel this week said we should be keeping an eye on March-in rights, patents, PBM and rebate reform, IRA and price negotiation and value. I might throw in 340B and state prescription drug affordability boards but it’s a nice catch up.