Unbiased Analysis of Today's Healthcare Issues
From CMS yesterday: On January 27, 2026, CMS announced the selection of the below list of 15 drugs payable under Medicare Part B and/or covered under Medicare Part D for the third cycle of negotiations (initial price applicability year 2028), based on total expenditures for drugs payable under Part B and/or covered under Part D…
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 question asked in a recent Health Affairs Forefront article by Peter Neumann, Josh Cohen, Sean Sullivan and Feng Xie. They compare the CMS negotiated prices for Initial Price Applicability Year (IPAY) 2027 against value-based prices (using QALYs) from the Tufts Cost-Effectiveness Analysis (CEA) Registry. The authors found that cost-effectiveness estimates varied among…
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…
Today, the Centers for Medicare and Medicaid Services (CMS) released the results from the Medicare Drug Price Negotiation Program for Initial Price Applicability Year (IPAY) 2027 (press release). What was the average reduction in drug prices? Across the 15 drugs included in the 2027 negotiation, on average, drug prices fell by 62% (median: 63%); accounting…
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…
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…
The Inflation Reduction Act (IRA) allows the Centers for Medicare and Medicaid Services to negotiate drug prices. However, CMS can only negotiated drug prices 9 years after drug approval for small molecules and 13 years after approval for large molecules. Why the difference? Do biologic treatments produce superior health benefits for patients? This is the…