News & Views: 11/30 - 12/6

December 7, 2021

President Biden spoke on prescription drug costs as Senate waits to vote on the Build Back Better Act.

Biden stressed that 1 in 4 Americans cannot afford their prescription drugs and nearly 30% of Americans have skipped doses of their prescriptions due to costs. He urged Senate to pass the Build Back Better Act, including the drug pricing provisions, because “everyone has less money in their pockets because high drugs costs make health insurance more expensive for everyone.” When asked, he did not promise that the package will be passed by Christmas, but that it will be passed as soon as possible. To read his full remarks, click here.

Reps. Earl “Buddy” Carter (R-GA) and Vicente Gonzalez (D-TX) reintroduced their Drug Price Transparency in Medicaid Act.

The bill would ban the use of spread pricing in Medicaid, a practice that allow PBMs to artificially inflate the price of prescriptions. PBMs charge plans more than they pay the pharmacy, then PBMs take the difference in those prices as their profit instead of passing the full payment to the pharmacy. The policy has been included in past bills, including the Democrats’ H.R. 3 and the Republicans’ H.R. 19. To read the full press release and bill text, click here and here, respectively.

Amgen joins other large drug manufacturers in limiting their participation in the 340B program.

Beginning January 3, 2022, Amgen will no longer provide 340B discounts for drugs dispensed at community-based pharmacies. According to 340B Health, Amgen will be the 10th manufacturer to restrict discounts since July 2020. To read the full article, click here.

ICER released their first annual assessment of barriers to fair access of US commercial insurance prescription drug coverage.

According to the report, fair access is evaluated through five major themes: the cost-sharing provisions and tier placements; timing of development of prior authorization protocols following FDA approval; clinical eligibility criteria; step therapy and requirements to switch medications; and restrictions on prescriber qualifications. ICER notes that a comprehensive report is not possible due to the lack of transparency between insurers and their coverage policies; increased transparency in this area is necessary to get a more complete picture. To read the full report, click here.

A new study by Urban Institute found that 13 million adults delayed or were unable to get their prescription drugs before COVID-19.

The researchers analyzed 2018-2019 data from the Medical Expenditure Panel Survey which is a nationally representative survey of US households. In addition to finding that 13 million adults were unable to get their prescriptions, the researchers found that 1 in 10 adults were uninsured all year (9.5%) or part of the year (11.6%). To read the full study, click here.

A new report by the PBM Accountability Project found that PBMs saw gross profits increase by 12% from 2017 to 2019.

In 2019, PBMs made $28 billion in gross profits, up from $25 billion in 2017. The report credited the increase in profits to be caused by practices such as spread pricing and claw backs, pharmacy fees, and claw backs. To read the full report, click here.

Researchers from PORTAL at Harvard Medical School analyzed spending on drugs that were granted accelerated approval from 2015-2019 in a JAMA study.

The researchers examined 66 drugs that had at least 1 accelerated approval indication with Medicare spending from 2015 to 2019. Annual spending on the drugs with an accelerated approval indication increased, however spending on the drugs with only accelerated approval indications decreased. Accelerated approval drugs were found to be 2.5% of total Part D spending and 16% of Part B spending in 2019. To read the full study, click here.

CIDSA Experts in the News

Ge Bai will be participating in the Rare Diseases: A Conversation on Value Assessments webinar hosted by The Hill on December 10. Bai and the other panelists will discuss the roadblocks that drug manufacturers face when developing orphan drugs and how to encourage orphan drug innovation while setting affordable prices for patients. To register for the webinar, click here.

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