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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.

Milena Sullivan

Part B Drug Negotiation Under BBBA Would Reduce Payments to Providers

New Avalere analysis finds that the latest version of Medicare negotiation in the Build Back Better Act (BBBA) would lead to a 40% cut on average for Medicare providers that furnish the Part B drugs that are likely to be initially targeted for negotiation.

Series of Changes to Drug Pricing Metrics Will Interact in Coming Years

The intersection of upcoming changes to drug pricing metrics will require new methods of calculating and reporting government pricing with implications for net pricing and contracting strategies.

Blair Burnett

Pending ASP Changes Impact Payments & May Shape Future FDA Filings

Beginning July 1, 2021, average sales price (ASP) calculations for Part B drugs with an additional non-covered self-administered formulation could alter Medicare reimbursement.

2021 State Drug Pricing Legislation: The Evolution Beyond Transparency

The majority of state legislatures are currently in session, and many states are taking steps to address prescription drug spending and prices through a range of legislative proposals. While states have historically focused on price transparency, state policymakers are now moving beyond those measures to more directly control prescription drug prices through reference pricing, affordability review boards setting upper payment limits, and other price control mechanisms.

Majority of Part D Spending Is on Brand Drugs in Classes with Generics

With Congress likely to consider a second reconciliation bill in the near future that may include various drug-pricing and Medicare Part D reform policies as spending offsets, an updated Avalere analysis examines spending across classes with various availability of brand and generic drugs.

Matt Kazan

Three Considerations for 2021 Drug Pricing Reform Outlook

A second reconciliation package could include significant drug pricing reforms as a means to pay for permanent coverage expansion and other top priorities.

Milena Sullivan

MFN Model Would Have Had a Major Impact on Certain Providers

New Avalere analysis finds that the the Most Favored Nation (MFN) Model would have a significant negative impact on Medicare providers that furnish Part B drugs—especially in oncology and rheumatology—and those in rural areas.

Massey Whorley

Podcast: Most Favored Nation Model Stakeholder Considerations

Tune into another episode of Start Your Day with Avalere. In this segment, experts from Avalere’s Policy practice discuss the Most Favored Nation (MFN) drug pricing model, how it works, and the implications for stakeholders.

Milena Sullivan

Most Favored Nation Rule’s Impact on Medicare Beneficiaries OOP Costs

New Avalere analysis finds that most Medicare fee-for-service (FFS) beneficiaries would not see a substantial reduction in their out-of-pocket (OOP) costs as a result of the Most Favored Nation (MFN) model.

Avalere Statement on Trump Administration Drug Pricing Reforms

Earlier today, the Trump Administration released long-anticipated drug pricing reforms, including rules related to a Most Favored Nation (MFN) approach for drugs administered by providers in Medicare and rebate reform for the Medicare Part D program. Both rules represent fundamental shifts in our current system and have significant implications for manufacturers, health plans, pharmacies, providers, and patients.

Milena Sullivan

Video: 2020 Election with Avalere: What Are the Drug Pricing Policies?

Tune into our third episode of the Avalere Health Essential Voice: 2020 Election series. In this segment, our experts discuss candidates’ respective approaches to drug pricing policies, and where there is unexpected overlap.

Milena Sullivan

Podcast: 2020 Election with Avalere: What Are the Drug Pricing Policies?

Tune into our third episode of the Avalere Health Essential Voice: 2020 Election series. In this segment, our experts discuss candidates’ respective approaches to drug pricing policies and where there is unexpected overlap.

Milena Sullivan

“Most Favored Nation” EO Creates New Questions on International Prices

On September 13, the Trump Administration released the much-anticipated “Most Favored Nation” (MFN) Executive Order (EO), calling for models that would cap the price Medicare pays for select Part B and D drugs. The President’s EO underscores the administration’s continued focus on reducing prescription drug price disparities between the US and other developed countries.

EOs Direct Drug Pricing Action, Raise Additional Questions

The administration’s 4 drug pricing EOs direct agency action across a host of policy areas, including Part D rebates, Part B reimbursement and pricing, 340B drug discounts, and drug importation. Next steps and a timeline for agency action will vary by EO dependent on the specific policies to be advanced or finalized. In the interim, stakeholders should explore outstanding questions and contemplate near- and longer-term policy scenarios.

Avalere Statement on Prescription Drug Pricing Executive Orders

On July 24, the administration released 3 executive orders (EO) and announced the planned publication of a fourth EO, all focused on prescription drug pricing. The EOs reflect a combination of familiar policy goals (e.g., rebate reform, importation, international pricing) and a new 340B initiative, and in combination could have substantial implications for healthcare stakeholders and pharmaceutical markets if implemented.

Podcast: E4 – Specialty Pharmacy Stakeholder Perspectives: COVID-19 Business Impacts

In the fourth episode of the Specialty Pharmacy Stakeholder Perspectives podcast series, Avalere is joined by Adam Hanauer, Associate Vice President at Humana Specialty Pharmacy, and Mark Sasala, Principal Business Analyst of Products at Creehan & Company, to discuss the outlook of specialty pharmacy with a focus on the environmental considerations and potential impacts of COVID-19.

Follow the Pill: Understanding the Prescription Drug Supply Chain

Prescription drugs are dispensed to patients through a complex supply chain that involves a broad array of entities, contract arrangements, and payments. The following diagram outlines how a typical prescription drug may flow through the drug supply chain.

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