Trump Moves Ball On Drug Prices
President Donald Trump registered more wins on drug price reform. The White House announced that nine additional pharmaceutical companies have agreed to follow a most-favored-nation (MFN) drug pricing policy, with some of the companies throwing in several months’ worth of emergency drug supplies.
As with other drug firms, the drug companies will lower the Medicaid prices for drugs that are more expensive than they’re sold in other countries, although prices are already deeply discounted through federal and state rebate programs. The firms will also deeply discount cash-pay customers’ drugs via the TrumpRx website. The deals also guarantee MFN prices on all new innovative medicines the nine companies bring to market.
Trump has now reached deals with 14 of the 17 drug makers to which he sent letters in July demanding that they lower prices.
At the same time, the Centers for Medicare and Medicaid Services (CMS) seeks to reduce Medicare drug costs through a pair of payment demonstrations announced Friday. CMS would tie the prices Medicare Part B and Part D pay for medicines to costs in foreign countries. The Global Benchmark for Efficient Drug Pricing Model, or GLOBE, would cover Part B drugs. A second mandatory initiative called Guarding U.S. Medicare Against Rising Drug Costs Model, or GUARD, would modify how inflation rebates for some Part D drugs are calculated. As with GLOBE, GUARD would link Part D drug prices to benchmarks based on international drug costs.
The models would run from 2027 through 2031, with rebate invoicing and reconciliation continuing into 2033.
Additional articles: https://thehill.com/policy/healthcare/5657095-trump-policy-pharma-agreement/ and https://www.beckerspayer.com/payer/cms-proposes-2-medicare-drug-pricing-models/
(Some articles may require a subscription.)
#drugpricing #branddrugmakers #trump
https://www.modernhealthcare.com/politics-regulation/mh-cms-globe-guard-medicare-drug-pricing
Trump To Demand Insurers Lower Costs
President Trump said he plans to hold a meeting with major insurance companies in the coming days in a bid to pressure them to lower prices for consumers who are set to see premium costs soar when enhanced Exchange subsidies expire.
In a new poll, almost 4 in 10 U.S. adults named healthcare or health issues as one of the top five issues they want the government to address in an open-ended question. The poll found that health care was the top issue for 45- to 59-year-olds, with 54 percent of the demographic ranking concerns as their top priority. It was the second most concerning topic for those over the age of 60, with 40 percent of the demographic flagging the topic as an issue.
Meanwhile, the door to a bipartisan deal hasn’t been completely shut, and it may not be too late to reverse looming cost increases if a deal is passed early next year. Moderate GOP lawmakers are especially worried about affordability.
In other news, a Becker’s Payer article discusses how 2026 could be the year of Individual coverage health reimbursement arrangements. These are payments to employees to buy their coverage in the individual market.
Additional articles: https://thehill.com/homenews/5657576-trump-pressures-insurers-lower-prices/?tbref=hp and https://thehill.com/policy/healthcare/5657331-healthcare-top-priority-americans/?tbref=hp and https://thehill.com/policy/healthcare/5656181-republicans-obamacare-subsidy-deal/ and https://www.beckerspayer.com/payer/ichra/will-2026-be-the-year-of-ichra/
(Some articles may require a subscription.)
#exchanges #healthcare #coverage
https://www.modernhealthcare.com/politics-regulation/mh-congress-aca-subsidies-democrats-premiums
New Price Transparency Reforms
The Centers for Medicare and Medicaid Services (CMS) released new regulations to toughen price transparency reporting by health plans. CMS proposed requiring carriers to:
- Exclude pricing information for services that a provider is unlikely to provide.
- Organize in-network pricing based on provider network.
- Update their pricing information quarterly with change highlights.
- Expand carriers’ out-of-network reporting requirements by lowering the claims threshold needed to report the rate paid to uncontracted providers to 11 claims over nine months, rather than 20 claims over 180 days.
- Require carriers to organize their out-of-network allowed amounts at the product level.
The agency will disclose the price consumers pay for prescription drugs in a separate rule.
Additional articles: https://www.modernhealthcare.com/politics-regulation/mh-cms-transparency-in-coverage-rule-insurance/ and https://www.cms.gov/newsroom/press-releases/trump-administration-proposes-significant-updates-disclosure-requirements-make-health-care-prices and https://www.beckershospitalreview.com/finance/cms-proposes-new-price-transparency-rules/
#healthplans #cms #pricetransparency
United Releases Outside Review Results
UnitedHealth Group Inc. released the first outside reviews of its business practices. FTI Consulting and Analysis Group found policies to be robust while pointing to ongoing problems in areas that have faced scrutiny. The initial reviews focusing on risk assessments in Medicare Advantage, care services management at UnitedHealthcare and policies at Optum Rx around drug manufacturer discounts.
Additional article: https://www.modernhealthcare.com/insurance/mh-unitedhealth-consultant-review-stephen-hemsley/
(Some articles may require a subscription.)
#unitedhealthcare #radv #overpayments #riskadjustment
— Marc S. Ryan
