Republican Efforts to Block Value-Assessment for Medicare Will Result in Outsourcing
The US Congressional Budget Office (CBO) has estimated that the new drug pricing reform in the recently-passed Inflation Reduction Act will save $100 billion over 10 years, even with the small number of drugs facing Medicare negotiations. Implementation will require intensive value-assessment, but Republican lawmakers have balked at the idea, claiming it will unduly burden some individuals and stifle innovation. Value-assessment will still be necessary, and an alternative metric is external reference pricing (ERP).
Medicare 340B Brawl Drags On
The ongoing battle over the Medicare 340B program rages on, in and out of the courthouse. The program, which requires a discount on drugs to health systems that primarily serve underinsured patients, was cut back by the Trump administration. These cuts were challenged in a series of legal battles that led to a Supreme Court decision in favor of the 340B program.
Half of Medical Loss Reports are Incomplete
The US Office of Inspector General (OIG) announced that nearly half of the medical loss reports (MLR) submitted by Medicare managed care plans were incomplete. The plans are supposed to send reports containing specific information, including data for MLR calculations. As a result, the OIG is calling for more oversight at the state level.
US Drug Pricing Reform May Help Medicare Part D Beneficiaries with High Cancer Costs
Many US cancer patients enrolled in Medicare Part D programs forgo life-saving cancer care due to exorbitant treatment costs, which average out to $3,000 out-of-pocket for the first month’s prescription. According to a White House blog posted last Friday, April 23rd, new provisions in the Inflation Reduction Act’s drug pricing reform would help reduce costs for Part D patients and the healthcare system at large.
Amazon, Walmart and Other Providers Ask US Congress to Extend COVID-19 Telehealth policies
A group consisting of 370 care providers has asked the US Senate to extend pandemic policies regarding telehealth. These policies provide extra flexibility to telehealth services, like cross-state services or the relaxation of in-person visits for mental healthcare. The organizations consist of massive providers like Amazon, Walmart, and many others.
Healthcare Price Transparency Rules Haven’t Helped Patients Yet
Despite a recently implemented rule requiring insurers to disclose what they pay for different kinds of care, patients have yet to benefit. The Centers for Medicare and Medicaid Service (CMS) also requires healthcare systems to do similarly. Unfortunately, a patient advocacy org has found these rules have not driven down health care prices for patients.
COVID-19 Antibody Treatments Continue Well After FDA Deauthorization
Despite the best efforts of the US Food and Drug Administration (FDA), the use of Eli Lilly and Regeneron’s monoclonal COVID-19 antibody treatments is still prevalent. Nearly 160,000 doses of the therapeutics have been given since the two were deauthorized by the FDA this January. An estimate of the total healthcare cost is approximately $71 million.
Cytel Webinar: US Drug Pricing Reform: Potential impact on Pharma HEOR Evidence Generation – September 8th
The new drug pricing legislation passed by the US government is set to change the game for the pharmaceutical industry. Medicare will negotiate the prices of certain drugs, so making a convincing case for a drug’s value is more important than ever. In a new Cytel webinar on September 8th, Cytel’s Anna Forsythe and Dr. Edmund Pezalla of Enlightenment Bioconsult will discuss the effects of the new legislation on drug pricing and how to use health economics and outcomes research (HEOR) in value assessment.
Analysts Suggest Impact of Drug Pricing Reforms Would be Limited
Despite a litany of complaints and concerns from the industry, the new US drug pricing reform passed by the Democrats would have a marginal impact on pharma, according to analysts from the Bank of America and UBS. The legislation will allow Medicare to set Part D prices for some medications, 10 by 2026 and 60 by 2029. In addition, the Centers for Medicare and Medicaid Services (CMS) will be able to negotiate part B prices.
Exploring the Process for the Inflation Reduction Act Drug Price Negotiations
The Democrats’ Inflation Reduction Act includes a provision to let the US government negotiate the prices of certain medications for Medicare recipients. If passed, Medicare would be able to negotiate the price of 10 drugs in 2026 and another 20 by 2030. The slate of drugs targetted would include expensive brand-name drugs for conditions like cancer, diabetes, and HIV. Any drugmaker that backs out of the deal would face up to a 95% tax on prior-year sales, an incentive panned by the industry
Inflation Reduction Act Maintains Expanded Health Insurance Subsidies
The Inflation Reduction Act, passed by the US Senate this Sunday, would preserve healthcare subsidies for 13 million people who purchase care through the marketplace. The bill, if passed by the House, would extend the subsidies through 2025. Originally, the subsidies only extended to the end of 2022.
US Senate Passes Democrat’s Flagship Climate, Drug Pricing, and Tax Bill
After months of negotiations and setbacks, Democrats in the US Senate have passed a pared-down version of their tax, climate, and drug pricing reform bill. Included in the bill is a provision that would limit the price of Insulin to $35 a month for Medicare recipients. Previous iterations of the bill that would have capped prices for patients on private care plans were struck down by Senate Republicans. The passage of the bill comes after Sen. Joe Manchin (D-W.V.) reached a last-minute agreement with Senate Majority Leader Chuck Schumer.
Analysts Project Four Major Pharma Companies Most Hit by US Drug Pricing Reform
As the US Senate moves closer to passing a bill that would allow Medicare to negotiate drug prices, analysts are busy projecting the impact to the pharma industry. According to analysts from SVB Securities, Eli Lilly, Abbvie, Johnson & Johnson, and Astrazeneca will be especially impacted if the proposal passes.
US Congress Makes Another Push for Drug Pricing Regulation
With tough odds in the upcoming midterm elections in mind, Democrats in the US Senate are making another push for drug pricing regulation. The latest attempt would limit the out-of-pocket drug costs to $2,000 and let Medicare negotiate drug prices. The proposal would also let the Department of Health and Human Services (HHS) select a small set of drugs for price negotiation, beginning with 10 in 2026 and steadily increasing as time passes.
Using Technology and Supplemental Services to Improve Health Outcomes in Medicare Advantage Members
Medicare Advantage (MA) plans are increasingly focusing on tackling health inequities. Social determinants of health (SDOH) like income, food, shelter, [...]
Lawmakers Call for Better CMS Oversight of Medicare Advantage Plans
Lawmakers in the US House of Representatives have expressed their concerns over the Center for Medicare and Medicaid Services’ (CMS) [...]
US Supreme Court Won’t Hear UnitedHealth’s Medicare Advantage Lawsuit
UnitedHealth was handed a major setback Tuesday, June 21st, when the US Supreme Court declined to hear its lawsuit over [...]
Supreme Court Issues Unanimous Decision in 340B Case in Favor of Hospitals
The US Supreme Court has issued its highly-anticipated decision in the Medicare 340B case, ruling unanimously in favor of hospitals. [...]
A Quarter of Medicare Recipients Experience Harm During Hospitalization
A newly released report from the US Department of Health and Human Services (HHS) finds that 25% of Medicare [...]
Alternate Payment Models to Increase Equity for Dually Eligible People
Medicare beneficiaries that are dually enrolled in Medicare (duals) are more likely to have social determinants of health (SODH) that [...]
Health Affairs Podcast: Why Some Medicare Beneficiaries Aren’t Filling Specialty Drug Rxs
As prescription drug prices rise, many patients are forgoing life-saving medications – even when they have insurance. Analysis by the [...]
CMS Announces 8.5% Increase in Medicare Part D and Medicare Advantage Rates
The Centers for Medicare and Medicaid Services (CMS) and the Biden administration have finalized rate hikes of 8.5% for Medicare [...]
Regional Variations in Hospital Pricing Represent Potential Policy Target
The RAND Corporation recently published a report finding that, although hospitals’ commercial payer prices didn’t vary widely from Medicare prices, [...]
Access to Alzheimer’s Drugs in Question Due to Medicare Draft Coverage
The draft guidance released by the Centers for Medicare and Medicaid Services (CMS) regarding coverage for the Alzheimer’s drug Aduhelm [...]
Alzheimer’s Advocates Ask US Govt to Approve Aduhelm Medicare Reimbursement
In response to Medicare’s decision to only cover the Alzheimer’s drug Aduhelm in clinical trials, patient advocacy groups have begun [...]
