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.

Megan West

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.

Shivani Patel

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.

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.

Ekemini Isaiah

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.

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.

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