Unbiased Analysis of Today's Healthcare Issues
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…
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…
While CMS has a target of getting 100% of Medicare beneficiaries into value-based payment (VBP) programs–such as accountable care organizations–by the end of the decade, implementing VBP in practice will be challenging. An editorial by Navathe et al. (2024) in Health Affairs provides some key considerations. Providers forego certain revenue for uncertain ‘bonus’ payments. “One…
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 Kaiser Family Foundation (KFF) identifies the Part D drugs on which Medicare spends the most money. This is an important question since CMS will begin drug price negotiation under the Inflation Reduction Act (IRA) based on the top 10 top spending Part D drugs. Some relevant statistics and figures are below. In 2021, Medicare…
An interesting article by Mor (2023) examines the history of the requirement for a 3-day hospital stay for Medicare to cover a skilled nursing facility (SNF) transfer. The 3-day requirement: …was introduced very early in the history of the Medicare SNF benefit at a time when most nursing homes (NHs) offered primarily custodial care and…
That is the title of a new USC Schaeffer Center white paper authored by Dana Goldman, Joe Grogan, Darius Lakdawalla, Barry Liden, Kyi-Sin Than, Erin Trish and myself. An excerpt from the press release is below, and the full white paper is here (HTML, PDF). 1. Bring transparency and a focus on value to the…
When you buy a car, there is the sticker price and what you actually paid after haggling with the dealer over discounts. For pharmaceuticals, the media typically reports on list prices which are analogous to the “sticker price” for cars. However, what really matters is the net price, which is the price after discounts and…