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Drug Pricing

Keep up with our comprehensive coverage of administrative and legislative activity and what it means for industry, plans, providers, and patients.

Madison Davidson

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.

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.

Kelsey Lang

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.

Tom Kornfield

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.

Anna Neumann

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.

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.

Kylie Stengel

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.

Massey Whorley

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.

Mariia Salova

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.

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