According to aides and a lobbyist familiar with the discussion, most at risk of being removed from the package are three of the major drug pricing proposals. The proposals to limit price increases to inflation, increase middlemen transparency, and cap insulin to $35 per month are most at risk as the majority of the savings come from changes to the commercial market. To read the full article, click here.
The arguments are centered around the changes that HHS made to the 340B program payment rules in 2018 which cut the rate from 106% the average sales price to 77.5% of the average sales price. The American Hospital Association argued that the reduction cost hospitals $1.6 billion and that HHS did not obtain any survey data on drug acquisition costs before deciding to reduce the rates. The decision on if HHS acted within their authority to set payment rates is not expected until sometime next summer. To read the full article, click here.
Rachel Sachs and her colleague wrote a perspective piece in the New England Journal of Medicine on the impact that Medicare coverage of aducanumab would have on state budgets. While there has been significant push back for Medicare to cover the $56,000 drug, a restrictive coverage determination would shift the costs to the state Medicaid budgets. The authors review possible legal pathways that states may take, but if CMS acts as it has in the past it is unlikely Medicaid will be able to refuse coverage for aducanumab. To read the full article, click here.