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Summary: What’s on the Horizon for US Drug Pricing Policy in 2019 and Beyond?

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On October 25, Avalere experts came together to discuss the latest policy developments related to drugs.

The webinar featured:

Matt Brow, President
Elizabeth Carpenter, Senior Vice President, Policy
Miryam Frieder, Vice President, Policy
Lance Grady, Vice President, Market Access & Reimbursement
Milena Sullivan, Director, Policy

The discussion focused on the following topics:

  • Drug Pricing Blueprint Themes and Related Policy Activity
  • Part B Reforms
  • New Medicare Formulary Flexibilities
  • What to Watch

Drug Pricing Blueprint Themes and Related Policy Activity

Earlier this year, the Trump administration released a drug pricing blueprint and request for information. The Blueprint focused on the following areas: enhanced competition, management, and negotiation; transparency; and value-driven incentives. Since the blueprint’s release, the administration has proposed or implemented several major drug pricing policies.

Part B Reforms

Avalere experts discussed the policies the administration could pursue to reform Part B, several of which later appeared in the administration’s proposed International Pricing Index (IPI) Model, which was announced by President Trump immediately following the webinar. The IPI Model incorporates an international drug pricing index, negotiation of Part B drug prices by independent vendors, and a change to the Average Sales Price reimbursement methodology.

New Medicare Formulary Flexibilities

Recent administration activity has focused on increasing formulary flexibility in Medicare. Policy changes include allowing Medicare Advantage (MA) plans to implement utilization management for Part B medicines and permitting Part D plans to implement indication-based formulary design.

What to Watch

Two proposed rules related to drug policy are expected in the coming weeks. The first is expected to address the Part C and D programs, while the second is expected to address rebate practices in the Part D program.

Listen to the webinar or access the slides. Please contact Courtney Rodgers if you’d like more information.

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