Medicare Drugs Prices Analyzed
A good article in Health Affairs Forefront analyzes the final prices of the ten drugs subject to Medicare drug price negotiations for 2026. The analysis shows that savings are indeed achieved on a net basis when taking into account Part D rebates. However, the data also show that the new prices are far above net prices in other developed countries.
As I have argued, Medicare drug price negotiations amount to a cautious start. As the authors also note, the best prices CMS can negotiate are for those drugs that have close therapeutic alternatives or substitutes.
The authors also suggest that an ancillary benefit of the negotiation law is the publication of net prices. This could now drive changes in other lines of business.
(Article may require a subscription.)
#drugpricing #ira #branddrugmakers
https://www.healthaffairs.org/content/forefront/medicare-negotiation-tells-us-drug-pricing-u-s
Tracking Poll Shows Widespread Support For Drug Price Negotiations
A new Kaiser Family Foundation tracking poll finds that 85% of voters support allowing Medicare drug price negotiations – including 77% of Republicans, 89% of independents, and 92% of Democrats. At the same time, 65% of voters are unaware or unsure that there is a law allowing Medicare drug-price negotiations.
#drugpricing #ira #branddrugmakers
Top PBM Execs Say They Will Not Correct Hearing Record
Top pharmacy benefits manager (PBM) executives from CVS Caremark, OptumRx, and Express Scripts all indicated they will not correct the record and their answers for a recent House committee appearance. Chairman James Comer, R-KY, says the executives lied under oath and have threatened them with fines and jail time. Lawmakers from both sides of the aisle grilled the executives, arguing PBM practices are anti-competitive, hurt independent pharmacies, and have interparty transfers that inflate prices for employers and Americans.
I feel bad for the executives. They were defending their companies. While some reforms are needed for sure, PBMs have become a scapegoat and I have defended some of the value PBMs’ bring. The GOP is not coming out against brand drug makers, who I view as the real culprits. Taking action against them would be highly unprecedented. But it does show that PBM reform is likely on its way.
#pbms #drugpricing
Paragon Institute Predicts Far-Reaching Medicaid Changes Not Likely
The conservative Paragon Institute’s president predicted that far-reaching Medicaid reform such as block grants or per capita caps is not in the making in the near term. He does not see the necessary support in Congress. More likely would be the GOP supporting work requirements and rolling back some enhanced reimbursement for the expansion populations. Paragon supports the phasedown of the reimbursement for expansion populations as well as lowering the current minimum reimbursement floor in Medicaid law below 50%.
(Article may require a subscription.)
#medicaid #aca #obamacare
Community Health Plans Want Feds To Intervene with Medicaid Agencies On Rates
The Alliance of Community Health Plans, which represents community-based health plans, is asking the Department of Health and Human Services (HHS) to help plans receive adequate payments from state Medicaid agencies. ACHP says a number of things are impacting them, including a sicker risk pool post Medicaid redeterminations restarting and the high cost of certain drugs (such as GLP-1s) and therapies. As ACHP notes, states are required to award actuarially sound rates in Medicaid managed care.
(Article may require a subscription.)
#medicaid #managedcare
Mercer Says Employer Healthcare Costs To Rise By Almost 6% in 2025
Consulting firm Mercer says U.S. employers expect health insurance costs to rise an average of 5.8% in 2025. Both inflation and utilization is driving the high increase. This will be the third consecutive year of hikes greater than 5%.
#employercoverage #healthcare
STAT Reviews MA Plans’ Expected Benefit Reductions
Interesting STAT article that reviews the pivot of Medicare Advantage (MA) plans from attracting members to reduction of enrollment. Major benefit reductions are being slated due to profitability concerns.
(Article may require a subscription.)
#medicareadvantage
— Marc S. Ryan
