News & Views: 6/22- 6/28

June 29, 2021

The Biden administration submitted a Request for Information (RFI) for health plan reporting of pharmacy benefits and prescription drug costs.

The RFI issued by the Departments of Labor, Treasury, and HHS specifically requests how health plans should “report pharmacy benefits and prescription drug costs under the transparency provisions of the Consolidated Appropriations Act of 2021.” The departments’ plan is to analyze prescription drug spending across the health plans. The analysis will then be used by plans to allow them to negotiate better benefits and lower costs for patients. To read the full RFI, click here.

Senators Crapo (R-ID) and Burr (R-NC) reintroduced the Lower Costs, More Cures Act to address high prescription drug costs.

In their press release, the Senators focus on the pharmaceutical industry’s work to combat COVID-19 as the reason to must protect innovation at all costs as Congress looks to address high drug prices. Among other provisions, the bill will cap Medicare Part D out-of-pocket costs, decrease cost sharing before the cap is reached, and cap insulin prices at $35 for Part D beneficiaries. To read the release and bill summary, click here and here, respectively.

Biogen announced they are willing to lower the $56,000 price of Aduhelm if prescribed more than expected.

While Biogen, according to their press release, determined the launch price of their new Alzheimer’s drug by how significant they felt the impact of treatment will be and the size of the patient population (based on entry of the clinical trials), there has been significant criticism in the past few weeks regarding the high price. In their attempt to make the new drug more accessible, Biogen announced they are willing to engage in a volume-based discount with CMS to ensure access to Medicare patients. To read the full press release, click here.

IQVIA released a new report on the growth of the biologic market and need for biosimilar sustainability.

The report highlights common barriers that countries face while trying to introduce more biosimilars to market. The recommendations to increase biosimilar sustainability include updating purchasing policies, incentivizing prescribers to choose biosimilar options when available, and increasing physician and patient awareness of biosimilars. The report acknowledges that biosimilars have long been a means to lower pharmaceutical spending on the costliest biologics and increase future innovation, however the slow uptake in biosimilars has not led to these outcomes. To read the full report, click here.

Five Blue Cross Blue Shield plans announced a new for-profit company, Evio, that will combat high drug costs.

Evio will compile data from the plans’ more than 20 million members to analyze how drugs perform over patient types and comorbidities. The goal of Evio is to have drug companies agree to outcomes-based contracts, where the plans will only need to pay in accordance with the drugs’ effectiveness. While there is little precedent for this currently, the plans are optimistic that their robust data will incentivize the drug companies to participate. To read the full announcement, click here.

CIDSA Experts in the News

Rena Conti and Richard Frank, along with colleagues, coauthored a Health Affairs blog post on necessary Medicare Part B reforms. The authors propose four reforms to counteract the existing perverse incentives in Part B. In addition to allowing the HHS Secretary to negotiate for Part B drug prices, they recommend add-on payments to be capped at $1,000, competition between original products and biosimilars, and the FTC investigate specialty drug manufacturers more aggressively. To read the full article, click here.

Sean Dickson spoke with Inside Health Policy reporters after Biogen announced that they are willing to engage in a volume-based discount with CMS. Dickson explains that a volume-based discount will encourage higher utilization; due to the broad FDA approval 6 million patients could be prescribed the drug rather than the 2 million patients who are in early stages of the disease, which was the estimated target population based on clinical trials. Rather, Dickson believes that Biogen should announce that they are cutting the price due to the “extreme nominal value of the drug.” To read the full article, click here.

Stacie Dusetzina was interviewed by the Health Affairs Editor-in-Chief on the Health Affairs podcast, A Health Podyssey. Dusetzina discussed a previous paper she coauthored on out-of-pocket spending for commercially insured individuals. To listen to the full podcast, click here.

Stacie Dusetzina also spoke with Vox reporters on the impact that Aduhelm will have on future pharmaceutical innovation. Dusetzina discussed the dangerous precedent that this approval has created, as investors and innovators may no longer feel the need to “push for something more complicated.” To read the full article, click here.

Rachel Sachs spoke with reporters from Fierce Pharma on how Aduhelm will impact the Medicare program and its beneficiaries. Sachs discussed how the approval of Aduhelm is the most controversial FDA drug approval and the estimated spending associated with it is problematic as there is no clinical value to the drug. To read the full article, click here.

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