In response to the executive order on price and quality transparency, CMS, the Department of Labor, and the Department of the Treasury issued a rule that will allow Americans to know how much their healthcare will cost in advance of seeking treatment. As part of the final rule, health plans will be required to make pricing information available to the public as of January 2022. One portion of the required pricing information is the “… in-network prices for all prescription drugs, as well as their historical net price, which takes into account any rebates or concessions that a health plan receives after the point of sale.” To review the complete rule, click here.
The model will take effect in January 2021 and is expected to save more than 1.3 million seniors an average of $446 a year on their insulin. If the plan is as successful as predicted, Administrator Verma confirmed that CMS will look to apply the model to other costly drugs. To read the entire CMS op-ed, click here.
To ensure seniors have access to the vaccine, CMS released an Interim Final Rule with Comment Period (IFC) that states any vaccine approved by the FDA, either through Emergency Use Authorization (EUA) or licensed through the Biologics License Application (BLA), will be covered by Medicare as a preventative vaccine for no cost to seniors. The rule also increased Medicare hospital payments to cover COVID-19 therapeutics for Medicare beneficiaries. To review the rule, click here.
The manufacturer announced that they will continue to provide 340B discounts to contract pharmacies, but only as long as they are within 40 miles of a 340B eligible hospital. Novartis is the most recent large drug manufacturer to restrict their 340B discounts at contract pharmacies in the midst of the COVID-19 pandemic. To review the letter from Novartis, click here.
The study found that specialty drugs accounted for 37.7% of retail and mail-order prescription spending net of rebates from 2016-2017, even though they account for a small portion of retail prescriptions. Over the past few years, use and spending on specialty drugs has consistently increased and is expected to continue to do so as innovative treatments reach the market, which is challenging to both private insurance and Medicare Part D. Rebates reduced significant increases in net spending, but spending net of rebates tripled for Part D and doubled for private insurance. To review the full study, click here.
The report found that while generics had been decreasing in price for much of the pandemic, prices are beginning to rise again. One notable exception is the steroid, dexamethasone, used with COVID-19 patients leveled off earlier in October. The report cited an increase of “$81 million in annualized inflation on generic oral solid ingredient costs for Medicaid” this past month, and while that would typically be high, the recent deflation over the past few months make this inflation not as significant. To review the complete report, click here.