News & Views: 1/4 - 1/10

January 11, 2022

HHS Secretary Becerra has requested CMS to revisit the 2022 Part B premium hike.

CMS announced Part B premiums would increase from $148.50 to $170.10, in large part to be able to cover the high price of Aduhelm. In the time since CMS made that announcement, Biogen has reduced the price of Aduhelm from $56,000 to $28,000. After Biogen made this announcement, Senators have urged Secretary Becerra to revisit the premium increase, as there is even less precedence for the historic increase. To read the full article, click here.

CMS announced a new proposed rule that is intended to lower out-of-pocket Part D drug costs and increase price transparency and competition.

The rule proposes a policy that was initially proposed in 2018 that would require Part D to apply all price concessions from pharmacies to the point of sale to reduce the beneficiary’s cost sharing. The rule will also hold more Medicare Advantage and Part D plans accountable for how Medicare revenue is spend to further increase transparency. To read the full press release, click here.

New York state has implemented a new law that requires PBMs to obtain licenses to operate in the state.

The law is intended to increase transparency surrounding PBMs for consumers, according to NY Governor Kathy Hochul. PBMs will be required to disclose revenue streams and details regarding their pharmacy networks to health plans and the NY Department of Financial Services (DFS). The DFS will be responsible for reviewing complaints and implementing fines if PBMs are found to be involved in anti-competitive behaviors. The Pharmaceutical Care Management Association (PCMA), a trade group representing PBMs claims that this law will only increase prescription drug costs in New York. To read the full press release, click here.

Drug price watchdog 46Brooklyn released a report on launch price increases.

The report found that launch prices of new drugs are increasing faster than prices for existing drugs. The weighted average price per claim for brand drugs increased from 58% in Medicaid between 109 and 2021 compared to the mere 5% increase in weighted average price for existing drugs. The difference in weighted average price increases was explained as being due to new drug launch prices. Additionally, the weighted average increase for all brand drugs was 3.8% in 2021, which is considerably lower than the 14.4% increase in 2013. To review all of the findings, click here.

CIDSA Experts in the News

Rachel Sachs reviewed 2021 prescription drug policy history as well as looking at potential policy routes for 2022 in a Health Affairs Forefront post. Sachs focused on the FDA’s response to the controversial Alzheimer’s disease drug, Aduhelm, and their response to COVID-19 vaccines. She also discussed policy decisions that must occur in 2022, including the NCD for Aduhelm, FDA approvals, the User Fee Amendments, and ongoing litigations. To read the full article, click here.

  • To listen to Sachs discuss the article in Health Affairs This Week, click here.

Rachel Sachs discussed the potential for CMS to cover Aduhelm in a Washington Post 202 article. Sachs is quoted as saying that we “might see CMS start to push back here to say that just because the FDA decides the drug meets their standard of ‘safe and effective’ doesn't mean it meets the Medicare standard of ‘reasonable and necessary,’” when asked about Medicare’s options to cover the drug. To read the full article, click here.

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