With the exception of the ending of demos/models at the Centers for Medicare & Medicaid Innovation (CMMI), most of the news kind of rolled over me this week. So, instead, here is a capture of what is rattling around my chamber of health policy worries.
Who’s on first? What’s on second? I don’t know … what will happen with the Medicare Part D rule on covering obesity medication that will also apply to Medicaid. On one hand, these are amazing drugs and having broader access to them could be fantastic as we approach the implementation of Medicare negotiated prices (hello, Wegovy.) But… that is a huge burden for Medicaid to have to cover when the federal government is looking to cut Medicaid spending. The rule is at OMB for review and usually would come out by early April at the latest for 2026 plan year consideration. But with no head of Medicare (yet), the priorities seem unclear.
Rules are made to be broken. And yet we have no idea what the rules really are around 340B so it feels like billions in revenue that just sits out there, adrift. Define a patient. What can 340B entities spend the revenue on? Or what can’t the 340B entities spend the revenue on? Manufacturers should be able to audit the program but are met with roadblocks. When manufacturers try a workaround and say they will get the data and then pay, the government says that is not permitted. It just gets tiring seeing the industry be told to shut up and pay. The 340B program has gone from $12B in 2015 to over $66B in 2023 and the non-exist rules are still there. There absolutely is good happening in 340B, but not enough.
Follow the post. Mark Cuban posted about Medicare Advantage commissions (thanking MedPAC for their work, very niche) and commented on a post from Brian Reid about Part D and how it encourages Medicare Advantage enrollment. The whack-a-mole of political targets is always shifting (hospitals, providers, pharma) – if we do not get pharmacy benefit manager reform, is Medicare Advantage next? It has been a beat since they were on the hot seat.
Stella-ra. So many biosimilars of Stelara are ready to go and at huge savings to the reference product, can biosimilars be saved? I hope so. These are coming in so far under the Medicare negotiated price that I am trying to be optimistic that there is a future for biosimilars.
What is catching your eye these days?
