It 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 aspirational, at best. Included was the increase in the number of drugs to be negotiated in Medicare but no real detail there. And honestly, we’re going to hit a wall in the number of drugs available to negotiate, this just gets there faster. What I found more interesting was the proposal to get rid of biosimilar interchangeablity.
Is the Food and Drug Administration (FDA) on board with this? We saw a slight shove in this direction with the Part D proposed rule allowing for mid-year switching to non-interchangeables but this is another level. I disagreed with this policy because there is an interchangeability standard but if that separate standard doesn’t exist, I won’t make a sound?
What was also interesting is that pharmacy benefit managers are NOT anywhere in there. So, Congress spends a ton of time on the issue and nothing?
I wish I could quit you. 340B has become such a pain. Yes, there are entities that make good use of the $ but it is just a lot of money floating around without a lot of rules. It just means that the boundaries get stretched. Anywho. This week a federal court in Arkansas upheld an earlier ruling that states can prohibit the restriction of contract pharmacies in 340B. This feels like it is ultimately going to the Supreme Court but let’s leave that chat to the legal folks.
No such thing as a free lunch. IQVIA did an analysis on the impact of 340B on self-insured employers… 340B use translates to less rebates for their beneficiaries – a 4.2% increase in costs.
A push for MEPA. Senate Finance is looking to get pharmacy benefit manager (PBM) reform done sooner rather than later.
Cue the DTC ad. One night this week the nightly news had an ad for Wegovy highlighting its cardiovascular indication. Quick work! Thus far, obesity drugs have not been covered by Medicare Part D because they are considered being weight loss drugs which are prohibited under the Medicare Modernization Act of 2003. There was a push to differentiate weight loss and obesity (which seems fair) but the cardiovascular indication really changes the story. Seems like we’re moving to can be covered, will be covered is a separate question.
An out-of-pocket cap of $2k and access to these products could drive up spending really fast, even with manufacturer rebates. I doubt anyone would move to cover these mid-year because it wasn’t build into the premiums but 2025? Maybe?
Prime the pump. Eli Lilly is going direct to consumers with their Lilly Direct program (which will include Zepbound, their weight loss drug) and one of their fulfillment partners will be Amazon.
Aye. Colorado wanted to import drugs from Canada. Turns out manufacturers don’t want to be helpful in this endeavor. Colorado pushed on the FDA but the FDA said they don’t have the authority to force the sales to happen. And around we go.
Off a cliff. A nice resource to keep handy – drugs going off patent in 2024.