Drug Pricing
Keep up with our comprehensive coverage of administrative and legislative activity and what it means for industry, plans, providers, and patients.
How Do IRA Drug Pricing Policies Interact with One Another?
Stakeholders should consider the interaction of inflation-based rebates, AMP cap removal, and Medicare price negotiation in pricing and contracting strategies.
Insights on IRA Policies and Business Impacts Presented at Asembia
Avalere’s expert presentations at the AXS23 Summit described IRA drug-pricing policies and the law’s impact on patient access and affordability.
EOM Payment Methodology Updated as Start Date Approaches
Amid stakeholder speculation for the future of the EOM, CMMI continues to plan for July 2023 implementation and released key payment methodology details.
Do Drug Manufacturers Have the Evidence Needed for Price Negotiation?
Manufacturers may find significant gaps between their existing evidence and the negotiation data elements that CMS will evaluate during the negotiation process.
Operational Complexities of Providing Access to MFP for Part D Drugs
Stakeholders in the drug supply chain should consider operational complexities that will result from variable arrangements for accessing the MFP.
Webinar: Demystifying IRA Drug Price Negotiation
Avalere experts will explore the potential implications of the Inflation Reduction Act (IRA)’s Medicare drug price negotiation program guidance and discuss implementation strategies for the near- and long-term.
Medicare Drug Price Negotiation Guidance: Avalere Experts Respond
Guidance adds clarity on drug selection, maximum fair price application (MFP), evidence submission, and manufacturer engagement, but leaves questions on determining MFP.
Implications of Policy Reforms on Pharmacy DIR in Part D
The use of DIR in Medicare Part D has increased in recent years, and both the IRA and CMS rulemaking are likely to influence DIR dynamics in the future.
How Health Plans Use Value-Based Drug Pricing
Health plans and other payers can manage drug expenditures through value-based approaches that tie drug pricing to patient outcomes.
IRA Medicare Part B Negotiation Shifts Financial Risk to Physicians
IRA would lead to a minimum 47% add-on payment reduction on average for Medicare providers who furnish the Part B drugs initially targeted for negotiation.
Biden Orders HHS to Test Medicare, Medicaid Drug Pricing Models
President Biden’s executive order directs HHS to identify CMMI model options that could lower drug costs and promote access for Medicare and Medicaid enrollees.
Inflation Reduction Act Renews Focus on Value Assessment in the US
Government price-setting provisions in the IRA have highlighted the diverse nature and interpretation of value across the US healthcare system.
New Analysis of Trends in Part D Generic Tiering, Pricing, and Patient Spending
New Avalere analysis examines longitudinal trends across a cohort of generic drugs, finding increases in aggregate patient spending over time and in placement on higher tiers in Medicare Part D.
Drug Pricing Bill Could Reduce Manufacturer Revenue by Over $450B
Analysis of updated Senate drug pricing legislation shows Medicare negotiation could reduce manufacturer revenues by $165 billion in Part D and $290 billion in Part B from 2026 to 2032.
Updated Reconciliation Package Changes Drugs Eligible for Negotiation
An updated Avalere analysis finds that under the changes to the negotiation policy included in the revised version of the Senate reconciliation package, the 100 Medicare Part B and D drugs that are likely to be selected for government negotiation from 2026–2031 represent almost half (45%) of all Part B and D drug spending in 2020.
2024 Part D Bid Cycle Introduces New Considerations for Stakeholders
As Part D plans and manufacturers begin to prepare for the upcoming calendar year (CY) 2024 bid cycle, the evolving Part D market and policy landscape may significantly shape plan bid and formulary management strategies.
Some Medicare Part D Beneficiaries Pay Full Price for Generic Drugs
An Avalere analysis finds that, in 2020, 63% of Medicare Part D beneficiaries paid the full cost of their generic medications at least once during their initial coverage phase when the generics were on the preferred brand tier.
The Rare Disease Market: Policy Changes and Coverage Trends
Changes to rare disease policies and payers’ approaches to coverage could have significant impacts on product development, patient access, and reimbursement.
Stakeholders Should Prepare to Engage the USP This Fall
In 2022, USP will update the MMG and the DC, presenting key opportunities for stakeholders to evaluate placement of new and existing products.
Value-Based Arrangement Pricing Flexibilities Will Take Effect July 1
Starting July 1, manufacturers can report multiple best prices for some value-based arrangements, which may encourage broader use of innovative contracting.