Trump Won’t Reintroduce Drug Price Reform
Donald Trump is backing away from his previous support for some form of drug price reform. In his first administration, Trump proposed drug price negotiations for Part B medical drugs in Medicare and the eventual cap of prices to international benchmarks. The U.S. would pay the lowest of other nations. He indicated he wanted to extend the concept to Part D retail drugs as well. The change is surprising given polls showing overwhelming support for drug price reform across Democrats, Independents, and Republicans. The reform was pulled back by the Biden administration due to rule-making issues and poor design.
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#drugpricing #medicare #branddrugmakers
Democratic Senators Urge FTC To Investigate PBM Co-Manufacturing
Finance Chair Sen. Ron Wyden, D-OR, and Sen. Sherrod Brown, D-OH, want the Federal Trade Commission to investigate pharmacy benefits managers (PBMs) who have co-manufacturing agreements with drug makers to manufacture and market biosimilar drugs. The FTC is suing PBMs on insulin prices. The senators say the agreements could help PBMs capture additional parts of the drug supply chain, limit competition, and force patients to adopt its biosimilar. It would then capture the revenue via a sister company.
The concern is valid. CVS says prices for this Humira biosimilar will be 80% lower than the brand, but there already is some evidence that co-manufactured drugs can be priced excessively high. As an example, Blue Shield California just signed a deal directly with a manufacturer and will pay $525 per 30-day supply. This is well below the price of Humira but also what PBMs charge from a list price basis for their very own biosimilars — $1,000 to $1,300 for the big three PBMs. Humira has a 30-day list price of about $7,000, meaning CVS’ 80% discount is about $1,400. This roughly matches the range above. Bottom line: a transparent deal as opposed to one involving sister companies of PBMs can save another rough $800 per month or more.
#biosimilars #drugpricing #branddrugmakers
Healthcare Gets Coverage At VP Debate
Healthcare got some coverage at the vice presidential debate. GOP candidate JD Vance claimed Trump salvaged Obamacare and said Trump would not take away protections for pre-existing conditions. I have a blog appearing tomorrow on Vance’s revisionist history on Trump and Obamacare. Democrat Tim Walz said the GOP’s views would return the healthcare system to the pre-Affordable Care Act world and hurt coverage.
Additional articles: https://www.managedhealthcareexecutive.com/view/aca-got-airtime-in-last-night-s-vp-debate and https://insidehealthpolicy.com/daily-news/vance-says-trump-will-keep-aca-preexisting-conditions-protections-advocates-cry-foul and https://www.fiercehealthcare.com/regulatory/top-healthcare-quotes-vance-walz-vp-debate
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#election2024 #healthcare
https://thehill.com/policy/healthcare/4911761-vance-trump-affordable-care-act
Humana Stock Tumbles On Announcement of Star Rating Drops
Humana reported that the number of people in 4 Star or greater plans will drop from 94% in 2024 to just 25% in 2025. This will complicate Humana’s rebound from financial troubles as it impacts 2026 revenue. Much of the impact was caused by the drop of one very large Preferred Provider Organization (PPO) contract. It holds 45% of total enrollment as well as most employer group wraparound plans (EGWPs). Humana may have won more and more revenue over the years as other contracts were consolidated into the one PPO contract and enrollment grew. But it appears the complexity of the big contract made it hard to maintain strong Star scores. Humana is challenging the Star results as it missed higher ratings by small amounts on several measures.
Due to current financial woes, Humana exited some markets and reduced benefits. It expects to lose about 5% of its enrollees in 2025.
In addition, a good article on Star measure cut points increasing. As we noted at my business site, lilacsoftware.com, we attribute the major increases in cut points to the Tukey outlier methodology change as well as to the recovery of utilization in healthcare post-COVID pandemic. Even if a plan improved from 2024 to 2025, they could see lower scores because they did not keep up with all plan results as a whole.
Scores are now posted on Medicare Plan Finder so we are beginning to get word about 2025 Stars. So far, Humana is the only big plan reporting a major decline. We will see the full results on or around October 10.
Additional articles: https://www.beckerspayer.com/payer/humana-reports-major-decline-in-medicare-advantage-star-ratings.html and https://thehill.com/homenews/ap/ap-business/ap-quality-ratings-hit-to-key-medicare-plan-shakes-humana-stock/?tbref=hp and https://www.modernhealthcare.com/insurance/humana-medicare-star-ratings-stock-price-jim-rechtin and https://www.modernhealthcare.com/insurance/medicare-advantage-ratings-cut-points-cms-2025
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#cms #stars #medicareadvantage
States Missing Opportunities To Improve Maternal Health Access
States are missing opportunities to require Medicaid managed care organizations (MCOs) to improve maternal health access, according to the Department of Health and Human Services Office of Inspector General (HHS OIG). Few states require access to all maternal health provider types.
#primarycare #medicaid #managedcare
Media Focuses In On CVS Woes
Another article on the financial woes of CVS Health. CVS faces huge financial headwinds, a potential activist investor, and a decision on dividing up the company.
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#cvshealth #aetna
HHS Releases 2027 Drug Price Negotiation Guidance and Timeline
The Department of Health and Human Services (HHS) released new guidance and a timeline on scheduled 2027 price negotiations. The 15 new drugs subject to negotiations will be announced 2/1/2025. I have not digested either the guidance or the timeline document but will do so and report in soon if there is any major news.
#ira #drugpricing #branddrugmakers
— Marc S. Ryan
