Unbiased Analysis of Today's Healthcare Issues
Some hints–and only hints–were provided in a CMS press release on Wednesday. Lowering the cost of prescription drugs for Americans is a top priority of President Trump and his Administration. In accordance with the statutory requirements of the Inflation Reduction Act, the Centers for Medicare and Medicaid Services (CMS) released the list of 15 drugs…
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…
That is the title of an interesting panel from USC Schaeffer Center on Coverage with Evidence Development (CED). It includes an interview with Tamara Syrek Jensen, Director, of the Coverage & Analysis Group within the Centers for Medicare & Medicaid Services. After the interview, there is a panel discussion of academics with Darius Lakdawalla of…
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…
See my previous posts on IRA price negotiation on drug selection (Part 1) and manufacturer data submission (Part 2). Today we will talk about the negotiation process and how CMS will set the maximum fair price (MFP) How will CMS price across dosages? “CMS will base the single price on the cost of the selected…
What data do drug manufacturers need to submit to CMS as part of the IRA price negotiation? What data elements can they electively submit? The recent CMS guidance released May 3, 2024 outlines these elements. What mandatory data are manufacturers required to submit? On the mandatory side, drug manufacturers are required to provide CMS with…
One approach CMS has is the Cell and Gene Therapy (CGT) Access Model. Under the CGT Access Model, CMS (at the federal level) will negotiates outcomes based agreements (OBAs) with manufacturers, which will include pricing terms and outcomes to be evaluated. Then states can elect to participate in the contract terms negotiated by CMS or…
Here is the CMS Factsheet and news coverage from NY Times. The companies that make each of these drugs is listed below. Eliquis – Bristol Myers Squibb and Pfizer Jardiance- Boehringer Ingelheim and Eli Lilly Xarelto – Johnson & Johnson Januvia – Merck Farxiga – AstraZeneca Entresto – Novartis Enbrel – Amgen Imbruvica,- AbbVie and…
The U.S. is one of the the few developed nations without a government-run health technology assessment (HTA) body. Or are they? A recent perspective in the New England Journal of Medicine by Peter Neumann and Sean Tunis argues that the Centers for Medicare and Medicaid Services (CMS) already is serving as a de facto HTA…
In the short-run, the answer is likely ‘yes’. As COVID-19 (hopefully) slows and if economic growth remains strong, health care spending will fall as a share of the US economy. At least this is what the Office of the Actuary (OACT) at Centers for Medicare and Medicaid Services (CMS) thinks in their Health Affairs study…