Drug Pricing and Affordability
Keep up with our comprehensive coverage of administrative and legislative activity and what it means for industry, plans, providers, and patients.
340B Stakeholders Consider Impacts of Duplicate Discounts
Drug manufacturers, covered entities, and other 340B stakeholders have shown increased interest in 340B duplicate discounts.
State Copay Accumulator Bans Will Affect 19% of US Commercial Lives
19% of people enrolled in the US commercial insurance market will belong to a health plan that must count copay assistance toward patient cost sharing by 2024.
Key Stakeholders of the 340B Drug Discount Program
Key 340B stakeholders include the federal government, patients, pharmacies, drug manufacturers, PBMs, plans, and the 340B prime vendor.
What Is the 340B Prescription Drug Discount Program?
Section 340B of the Public Health Service Act requires significant discounts on outpatient drugs for “covered entities"—safety-net providers and programs.
Which Therapeutic Areas Are Likely to Be Affected by IRA Negotiation?
Sponsors with portfolio or pipeline assets within certain therapeutic areas can prepare for the downstream effects of price negotiation on the market.
Should Competitors of Negotiated Drugs Review Their Market Strategies?
Manufacturers of therapeutic alternatives to negotiation-eligible drugs should re-examine their commercialization strategies in response to market dynamics.
Should Competitors of Negotiated Drugs Review Their Evidence Strategy?
Manufacturers of therapeutic alternatives to negotiation-eligible drugs should examine their value and evidence strategy in response to new dynamics.
Will the IRA Change Investment in Orphan Drug Pipelines?
IRA negotiation eligibility criteria may impact orphan drug investment, affecting long-term innovation and patient access.
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.
CMMI Drug Pricing Model Concepts
CMMI releases long-awaited response to President Biden’s executive order on drug pricing with a directive for the Centers for Medicare & Medicaid Services (CMS) to develop three models.
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.
Copay Caps Could Reduce OOP Costs for Part D Beneficiaries
Analysis shows adding prescription drug copay caps to Part D benefit redesign could reduce OOP costs by 45% per enrollee.