Trump Executive Order Wants Deeper Drug Price Cuts
In yet another sign President Donald Trump will keep the Medicare drug price law, he issued an executive order that strives to get deeper price reductions in the second year of negotiations (2025 for an effective date of 2027).
The executive order is general. But it does commit to evaluating ways to ensure prices drop more than the average 22% seen in the 2024 negotiations, increase transparency, increase generic introduction and penetration, further importation, and reform pharmacy benefits managers (PBMs) and other middlemen. It also indicates special programs would be set up for the low income. The order will solicit information from the public and stakeholders.
On the other hand, Trump also said the actions would minimize any negative impacts of the maximum fair price on pharmaceutical innovation within the United States. This likely could mean protecting certain small molecule drugs longer from negotiations, which is known as the “pill penalty.” But that could also mean some shortening of large molecule drug protection. Healthcare policy group KFF lays out the impact to the number of drugs negotiated and lost savings if small molecule drug protection is extended. As I have said in the past, I have some sympathy for drug makers on the small molecule issue in terms of parity in the law.
Some are speculating that the order could throw out the entire gross and net price system by eliminating rebates.
The special program could leverage grant conditions at community health centers and other similar groups to lower costs of drugs by passing through discounts received. Others predict that there will be new conditions placed on 340B hospitals as well to pass through drug price reductions.
In two other encouraging signs, the order requires an evaluation of site-neutral payment reform and whether Medicare payment is encouraging a shift in drug administration volume toward costly hospital outpatient departments. Further, the Department of Labor will issue new transparency requirements to ensure that pricing and other arrangements of PBMs are made clear to employer groups that are self-insured.
In other news, Mark Cuban’s Cost Plus Drugs will target drug shortages through an agreement with those in the injectable drug market.
Additional articles: https://www.healthcaredive.com/news/trump-drug-pricing-executive-order-ira-pill-penalty/745539/ and https://insidehealthpolicy.com/daily-news/trump-targets-ira-drug-negotiation-imbalance-new-eo-offers-few-details and https://insidehealthpolicy.com/inside-drug-pricing-daily-news/drug-pricing-eo-reveals-plan-build-cgt-access-model-medicaid and https://www.healthaffairs.org/content/forefront/administration-lays-out-drug-pricing-plan-through-executive-order and https://www.kff.org/policy-watch/the-effect-of-delaying-the-selection-of-small-molecule-drugs-for-medicare-drug-price-negotiation/ and https://insidehealthpolicy.com/inside-drug-pricing-daily-news/eo-leverages-340b-insulin-medicare-pay-address-site-neutral and https://www.beckershospitalreview.com/quality/pharmacy/mark-cubans-drug-firm-targets-injectable-shortages/
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#drugpricing #trump #branddrugmakers #ira #transparency #generics #340b #siteneutral #pbms
Humana Loses Internal CMS Appeal
Humana reported that it lost its internal appeal to the Centers for Medicare and Medicaid Services (CMS) on the plans 2026 Medicare Advantage (MA) Star ratings. Humana is among about a dozen plans that have lawsuits pending in federal court. CMS Administrator Mehmet Oz could look at the issue.
Additional article: https://www.beckerspayer.com/payer/humana-loses-star-ratings-appeal/
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#medicareadvantage #stars #quality #humana #cms
https://www.modernhealthcare.com/insurance/humana-medicare-advantage-star-ratings-appeal
United Seeking To Reform Image And Practices
United Healthcare is seeking to remake its image and practices, including on prior authorization and denials, as it confronts the recent assassination of a top-level executive. There is bipartisan interest in reforming Big Healthcare and health plans.
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#unitedhealthcare #priorauthorization #claimsdenials
https://www.modernhealthcare.com/insurance/unitedhealthcare-tim-noel-prior-authorizations
Democrats Say Enhanced Premium Subsidies Should Stay Under GOP Budget Gimmick
The adopted budget reconciliation budget resolution is allowing the GOP to score the extension of the 2017 tax cuts as zero cost. Democrats say what is good for the goose is good for the gander. They argue that extending the Exchange premium subsidy enhancements would also be scored at zero under the interpretation. Republicans are refusing to weigh in right now. The enhancements expire at the end of 2025.
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#obamacare #exchanges #healthcare #coverage
https://www.modernhealthcare.com/politics-policy/senate-budget-tax-cuts-aca-subsidies
HIV/AIDS Funding Slated For Cuts Domestically
The White House budget office’s instructions for federal fiscal year 2026 call for eliminating the Ending the HIV Epidemic Initiative and the Minority AIDS Initiative. The administration also proposes eliminating Ryan White HIV/AIDS Program dental services, education and training centers and the Ryan White Special Projects of National Significance. International initiatives on AIDs are slated for a 40% reduction.
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#hivaids #healthcare
Medicaid Revolt in House
Twelve House Republicans in competitive districts sent a letter to top GOP leaders saying they will not support the budget reconciliation bills if there are Medicaid reductions to coverage. There is similar sentiment among some GOP senators. How GOP leaders thread the needle on some cuts to assuage conservatives and those not fundamentally impacting coverage will be very tough.
#budgetreconciliation #healthcare #medicaid #coverage
https://thehill.com/homenews/house/5251367-medicaid-cuts-house-republicans-2/?tbref=hpaca-preventive-services-supreme-court-kennedy-braidwood/
— Marc S. Ryan
