IRA Question of the Week: How Will Negotiation Affect Reimbursement?
The introduction of the maximum fair price through the Medicare drug price negotiation process is expected to lower provider reimbursement.
The introduction of the maximum fair price through the Medicare drug price negotiation process is expected to lower provider reimbursement.
The Biden administration’s budget outlines a healthcare policy agenda focused on drug pricing, coverage reform, infectious diseases, and biomedical research.
Guidance adds clarity on drug selection, maximum fair price application (MFP), evidence submission, and manufacturer engagement, but leaves questions on determining MFP.
Part D redesign and OOP smoothing shift financial liability from beneficiaries to plans, incentivizing utilization and formulary management.
The IRA will reduce out-of-pocket drug costs (especially in Medicare Part D), increase the availability of marketplace plans, and expand access to vaccines.
The first Insight in this series explores timing for Medicare negotiation, inflation rebates, and Part D benefit redesign changes and details to be defined.
The Inflation Reduction Act (IRA) brings some of the biggest changes affecting the pharmaceutical industry in the last decade. Avalere expert Megan West discusses how these shifts will impact pharmaceutical organizations and how Avalere can support in developing strategies to mitigate risk and identify opportunities across the product lifecycle.
Avalere expert Rebecca Yip discussed plan and beneficiary responses to IRA policies during our 2023 Outlook webinar.
The IRA’s drug price negotiation policies, extended marketplace subsidies, and Part D redesign will impact investors’ current portfolios and investment strategy in the future.
Avalere identified 19 states that must change their Medicaid vaccine policies to comply with the IRA’s requirement that states cover all recommended vaccines without cost sharing.
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.
The IRA will expand adult vaccine access by mandating coverage without cost sharing for all adult vaccines in Medicare Part D and Medicaid.