International Reference Pricing Bill To Lower Drug Prices Unveiled
Two senators, conservative Josh Hawley, R-MO, and progressive Peter Welch, D-VT, have introduced legislation to lower prescription drug prices. The bill would prohibit pharmaceutical companies from selling drugs in the U.S. at prices higher than the international average. This is a form of international reference pricing (IRP).
Trump proposed IRP for Medicare Part B drugs under Trump 45 and said he wanted to do so in Medicare Part D as well. The proposal was later pulled back by the Biden administration. Trump has now called for most-favored nation (MFN) pricing for Medicaid. MFN is a form of IRP.
Trump also unveiled a master executive order to reduce drug prices in America. This bill is an important development as it includes a conservative senator. It appears that populism is winning over the GOP, which is usually very friendly to Big Pharma. I can see Trump and the GOP in Congress getting together on major drug price reform.
#drugpricing #branddrugmakers #medicare #employercoverage #medicaid
Per Capita Caps On Reconciliation Table
Conservative House Republicans are pushing the concept of per capita caps in Medicaid to reduce long-term costs. Moderates oppose such changes due to the likely impact on coverage, but conservatives argue limiting long-term growth is fair game and not absolutely linked to coverage. According to the Congressional Budget Office (CBO), a per capita cap would cut federal spending by between $588 billion and $893 billion over nine years.
The conservatives and moderates also are trying to settle on a Medicaid reduction amount over the 10-year budget horizon. A number of about $500 billion is being considered. Moderates would need proof that coverage would not be fundamentally impacted.
Meanwhile, the healthcare policy group KFF has issued a brief on Medicaid, which includes a conclusion that one in five hospital days in almost all states is funded by Medicaid. Hospitals also are about one third of Medicaid spending.
Last, Democrats in states are having fun sponsoring legislation to amend trigger laws to call attention to the potential Medicaid cuts at the federal level. The Democrats are challenging Republican Governors to water down the trigger laws so that benefits stay in place regardless of the federal reductions.
Additional articles: https://www.modernhealthcare.com/politics-policy/medicaid-trigger-laws-congress-trump and https://thehill.com/policy/healthcare/5280452-medicaid-spending-caps-republicans/ and https://www.kff.org/medicaid/issue-brief/medicaid-covers-at-least-one-in-five-hospital-inpatient-days-in-nearly-every-state/
(Some articles may require a subscription.)
#medicaid #healthcare #coverage #budgetreconciliation #trump #congress
https://thehill.com/homenews/house/5282452-house-republicans-medicaid-cuts-salt/?tbref=hp
Tariffs Could Increase 340B Discount Costs
It is ironic, but tariffs on drugs could increase 340B drug discounts. Hospitals and other providers could get these higher discounts if drug makers and others pass the costs throughout the supply chain and ultimately to providers.
The Trump administration has proposed in an executive order to begin reform of the program. Increased costs could fuel this drive.
(Article may require a subscription.)
#340b #drugpricing #hospitals #providers #branddrugmakers
https://www.modernhealthcare.com/finance/drug-tariffs-340-discounts-hospitals
Oz’s AI And Interoperability Vision
Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz has crafted a health technology vision, which is far-reaching. It includes:
- Exploring artificial intelligence (AI) reimbursement
- Generative AI to cut regulations
- AI tools that support doctors
- Interoperability standards reforms
- Software to support price transparency goals
(Article may require a subscription.)
#ai #healthcare #cms #oz #interoperability
Q1 Health Insurer Profits Ranked
Becker’s Payer ranks healthcare entities (with insurance arms) profit for Q1 2025. While insurance arms are having some poor numbers, the overall health companies are reporting profits. Most of these entities have service units and pharmacy benefits managers.
#healthplans #margins
https://www.beckerspayer.com/payer/payers-ranked-by-q1-profits
— Marc S. Ryan
