Unbiased Analysis of Today's Healthcare Issues
There were lots of very interesting sessions at ISPOR 2025 in Montreal. One of my favorites that I was able to attend was titled “Medicare Price Negotiation of Part B Drugs: Implications for Provider Reimbursement and Commercial Spillover“. The session was moderated by Sean Sullivan of University of Washington, with Kristi Martin from the Centers…
In a statement today, CMS confirmed that Elon Musk and the Department of Government Efficiency (DOGE) has been given access to CMS payment systems: CMS has two senior Agency veterans – one focused on policy and one focused on operations – who are leading the collaboration with DOGE, including ensuring appropriate access to CMS systems…
Chuanzi Yue and Marisa Miraldo argue in a recent Health Affairs Forefront piece that the answer is ‘yes’, but I am highly skeptical of their claim. Will IRA cause firms to allocate funds from marketing to R&D? One point they make is that the IRA’s Medicare Drug Price Negotiation program will reduce pharmaceutical expenses on…
From the CMS document “Medicare Drug Price Negotiation Program: Selected Drugs for Initial Price Applicability Year 2027“: On January 17, 2025, CMS announced the selection of the below list of 15 drugs covered under Medicare Part D for the second cycle of negotiations (initial price applicability year 2027), based on total gross covered prescription drug…
At the end of last year, CMS finalized a rate cut for Medicare reimbursement to physicians. The CMS Fact Sheet states: …average payment rates under the PFS [Physician Fee Schedule] will be reduced by 2.93% in CY 2025, compared to the average amount these services were paid for most of CY 2024 This sounds like…
My FTI colleagues Mark Van Ert and Krunal Patel summarize some of the new quality measures that will be incorporated into the 2025 CMS Star Ratings that are used to evaluate Medicare Advantage (MA) plans. The CMS Star Ratings are very important as CMS payments to MA plans is expected to increase by 3.7% or…
Why were drugs not included in Medicare in 1965? And the answer is, because drugs didn’t matter. They were not all that good, and they didn’t do a lot… We now see pharmaceutical care as the heart of treating someone; not so then. Steven Grossman, Executive Director – Alliance for a Stronger FDA It’s amazing…
Medicare drug price negotiation is here. The maximum fair prices (MFP) set by Medicare lead to discounts between 38% and 79%. In fact, the real discounts are larger since the figures listed in the table below are discounts off of 2023 prices (rather than 2024 prices). How did the negotiation process work? CMS’s fact sheet…
Recently, the Inflation Reduction Act (IRA) is getting a lot of attention, particularly for its provision that allows CMS to start drug price negotiation for selected drugs 9 (small molecules) or 13 (biologics) years after drug launch. However, the Centers for Medicare and Medicaid Innovation (CMMI) has proposed a number of a number of payment…
Potentially so, argues Adam Fein of Drug Channels. There are two mechanisms for this. First, for drugs not covered in the maximum fair price negotiations, Fein argues that drugs with high list prices and large rebates would lead to more net savings compared to drugs with lower list price and rebates in part because in…