Unbiased Analysis of Today's Healthcare Issues
Medicare Drug Price Negotiation aims to reduce the prices paid for high cost pharmaceuticals. Traditionally, biologic drug price reductions after loss of exclusivity (LOE) have occurred due to the introduction of biosimilar competitors. A recent paper by Beinfeld et al. 2025 examines whether Medicare Drug Price Negotiation enacted under the Inflation Reduction Act (IRA) is…
That is the title of my new publication out today with the subtitle “A case study of rifaximin for the treatment of overt hepatic encephalopathy using QALY and non-QALY measures“. This was work with co-authors Shanshan Wang, Leonardo Passos Chaves, Olamide Olujohungbe, Sanjana Muthukrishnan, and Aditi Chaudhary. The abstract is below. BackgroundTraditional cost effectiveness analyses…
The Inflation Reduction Act (IRA) created the Medicare Drug Price Negotiation Program (DPNP). The aim of the program is to reduce the cost of pharmaceuticals for Medicare. A key question is how are investors viewing this policy and how is it impacting their investment decisions. A paper by Canestaro, Patterson and Campbell (2025) aimed to…
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…
Tariffs on pharmaceuticals. First, President Trump has voiced his goal to impose tariffs on pharmaceutical products made overseas. The New York Times reports: Mr. Trump said in remarks to reporters on Monday that pharmaceutical tariffs would come in the “not too distant future.”“We don’t make our own drugs anymore,” Mr. Trump said. “The drug companies…
As reported by EndPoints: President Donald Trump on Tuesday signed an executive order offering support for a change to the IRA’s “pill penalty,” one of the industry’s long-standing policy priorities that could affect billions of dollars in drug costs under Medicare. The executive order on drug pricing contains a grab-bag of policy proposals, some of…
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…
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…
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…