The bill, which was paired down from the original $3.5 trillion plan, ended up being a $1.7 trillion package. In addition to other healthcare provisions, the package allows for limited Medicare negotiation of the costliest drugs, inflation rebates, and a Part D redesign which included a $2,000 cap for seniors. Initially, negotiation was estimated to save $100 billion, but a last-minute change which allows biologics to be excluded from possible negotiations for an additional year resulted in a final savings of $79 billion. The inflation rebates would generate an additional $34 billion. Finally, the Part D reform would have a net savings of $1.6 billion. The savings from the final reconciliation bill are significantly less than the estimated $456 billion that H.R. 3 was scored to save. To read more, click here.
The interim final rule requesting information is the latest rule in response to the No Surprises Act and the transparency requirements of the Consolidated Appropriations Act. The objective of the rule is to create a biennial public report that will show prescription drug pricing trends and the impact of drug costs of premiums and out-of-pocket costs. The first report is expected in 2023 and they will be released biennially after that. The goal of this report is to increase transparency and evaluate how prescription drugs exacerbate the increase in health care spending. To read the CMS press release and fact sheet, click here and here, respectively.
The report evaluates 12 drugs that had significant price hikes in 2020, 10 of which were chosen based on price increases of the drugs with largest sales revenue and 2 of which were added based on public input. Of the 12 drugs evaluated, only three were shown to have new clinical evidence that supported their price increase, which were Venclexta, Cimzia, and Entresto. The total increase in spending in the US over the year due to price increases from seven of the nine drugs that did not have new clinical support was estimated to be $1.67 billion, the two publicly requested drugs were excluded from the net spending increase estimation due to available data. Humira (adalimumab) was the greatest driving factor of this increase; the one drug alone was responsible for $1.4 billion increase in spending. To read the full report, click here.
Stacie Dusetzina was a guest on PBS News Hour podcast to discuss if the Build Back Better bill goes far enough to lower prescription drug prices. While she acknowledges that the plan is significantly less than the initial plan in H.R. 3, Dusetzina notes that the policy still has potential to lower prices for patients. She believes that this limited bill will give further evidence that negotiation does not impact innovation or reduce access, so that we may see more negotiation in the future. To listen to the full podcast, click here.