Could Trump Bring Back International Reference Pricing
Interesting Forbes article alluding to a December dinner with President-elect Trump attended by Eli Lilly CEO David Ricks. Apparently, international reference pricing to set Medicare drug prices was discussed. Subsequently, Ricks has alluded to the need to increase prices abroad in developed countries, leading some to speculate Trump could re-issue his proposal for adopting the most favored nation prices for Part B medical drugs in Medicare. At the time, Trump said he might even make the proposal applicable to Part D retail drugs in Medicare.
During the campaign, he seemed to swear off the idea, but we know Trump changes his mind. He is also obsessed by being ripped off by other nations. Drug pricing is a great example. Drug makers agree to low prices in other developed countries because America pays for the vast majority of its profits (about three-quarters). The money earned in other countries is gravy.
#drugpricing #branddrugmakers #trump #medicare #partd #partb
Speculation on DOGE Cuts
Fierce Healthcare looks at various possible reductions that the Department of Government Efficiency (DOGE) commission could make in Veterans’ programs, Medicare, Medicaid, and the Affordable Care Act (ACA). It also discusses the possibility of the president using impoundment. Many, including me, view that as usurping legislative authority.
I discussed impoundment in a blog today. I will have a major blog Thursday on this site on all the possible healthcare cuts. Stay tuned.
#2025 #trump #healthcare #spending #medicare #medicaid #aca #obamacare #exchanges #coverage #doge
https://www.fiercehealthcare.com/payers/how-doges-priorities-could-impact-medicaid-and-veterans
CVS Moves To Transparent Model in Commercial World
Recognizing changing times, all of the commercial prescriptions dispensed at CVS pharmacies will be processed through its CostVantage reimbursement model. Prescriptions are priced based on the underlying cost with a delineated markup and dispensing fee to cover the pharmacy’s services. CVS says the model makes it less necessary to raise the cost for certain prescriptions to cover losses on other drugs. It says the model will increase transparency for insurers and pharmacy benefit managers (PBM). CVS Caremark, its PBM, has also begun using transparent arrangement.
At the same time, transparent PBMs are beginning to gain traction after some wins with big health plans and employer groups. Many said 2024 was their largest selling year. Over 70% of employers worked with CVS Health’s CVS Caremark, Cigna’s Express Scripts and UnitedHealth Group’s OptumRx in 2024, but about half of companies are considering changing partners in the next one to three years. This is driven by a desire for transparent relationships and rising costs. Capture of significant market share, though, will be an uphill climb.
Additional article: https://www.modernhealthcare.com/insurance/navitus-health-solutions-smithrx-capital-rx-pbm-market-2025
(Some articles may require a subscription.)
#pbms #transparency #drugpricing
A Good Example Of Why Health Plans Have A Bad Name
Kaiser Health News tells of the plight of amputees seeking prosthetics from health plans as artificial limbs age and need replacement. I see this happening often regarding wheelchairs and other necessary items for those with disabilities as well. I know I helped a friend battle for coverage for a long time. It is a good example of why health plans have a bad name and need to reform somewhat.
#priorauthorization #healthplans
https://kffhealthnews.org/news/article/prosthetic-limbs-private-insurance-coverage-denials-amputees/
More States Covering GLP-1s Just For Obesity In Medicaid
More states appear to be covering GLP-1s for those who only have obesity and not other underlying disease states. Despite rising costs overall across the board for GLP-1s, more than a dozen states now cover such drugs just for obesity. North Carolina and South Carolina are the most recent to add the coverage.
#glp1s #weightlossdrugs #drugpricing #medicaid
— Marc S. Ryan
