Posts Tagged “Pharmacy Benefit Managers”

USA: The Fight To Lower Soaring Drug Prices Turns Bitter Between States And The Feds

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USA: The Fight To Lower Soaring Drug Prices Turns Bitter Between States And The Feds

Frustrated by federal inaction, state lawmakers in 41 states have proposed detailed plans to lower soaring prescription drug costs. Some measures would give state Medicaid agencies more negotiating power. Others would disclose the pricing decisions of the drug manufacturers and the companies that administer prescription drug plans.

The more ambitious proposals would bump up against federal authority, such as legislation that would allow importing drugs from Canada or alter federal statutes on the prices states pay for drugs in Medicaid. They likely would have to survive a challenge in federal court. And many likely would face resistance from a deep-pocketed pharmaceutical industry.

According to the National Institute on Money and Politics, a nonprofit that collects campaign finance data, the pharmaceutical industry in 2018 contributed nearly $19 million to state campaigns, and $56 million to federal ones.

“States are limited in power in this area,” said Rachel Sachs, a health law expert at Washington University in St. Louis School of Law. “But one of the impacts of these efforts is to put pressure on the federal government, and force it to justify its actions to stymie the states.”

President Donald Trump has criticized soaring drug prices, and on Thursday the Department…

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USA: Trump wants to slash drug rebate deals. Will it make a difference?

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USA: Trump wants to slash drug rebate deals. Will it make a difference?

Few consumers have heard of the secret, business-to-business payments that the Trump administration wants to ban in an attempt to control drug costs.

But the administration’s plan for drug rebates, announced Thursday, would end the pharmaceutical business as usual, shift billions in revenue and cause far-reaching, unforeseen change, say health policy authorities.

In pointed language sure to anger middlemen who benefit from the deals, administration officials proposed banning rebates paid by drug companies to ensure coverage for their products under Medicare and Medicaid plans.

“A shadowy system of kickbacks,” was how Health and Human Services Secretary Alex Azar described the current system in a Friday speech.

The proposal is a regulatory change applying only to Medicare plans for seniors and managed Medicaid plans for low-income people. But private insurers, who often take cues from government programs, might make a similar shift, administration officials said.

Drug rebates are essentially discounts off the list price. Outlawing them would divert $29 billion in rebates now paid to insurers and pharmacy benefit managers into “seniors’ pocketbooks at the pharmacy counter,” Azar said.

The measure already faces fierce opposition from some in the industry and is unlikely to be implemented as presented or by the…

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Both parties want lower drug prices but gridlock prevents reform

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Both parties want lower drug prices but gridlock prevents reform

I went to Walgreens recently to pick up my three-month supply of a prescription I have been using for years. Ho hum. Until I saw what it was going to cost.

All of a sudden the price had gone up by more than 20 percent. I paid it, of course, grumbling. But I decided to do some research into what’s going on with America’s prescription drug prices.

Bloomberg News looked into drug prices last year and found that “255 brand name drugs had increases between Feb.1 and July 13 … the most common increase was for 9 to 10 percent.”

It also tracked the prices for 40 commonly used drugs in six categories — diabetes, cancer, HIV, multiple sclerosis, asthma and chronic pulmonary disease, and autoimmune diseases such as rheumatoid arthritis and psoriasis — over a three-year period from June 2015 to June 2018. During this period the consumer price index went up by 5.6 percent.

“For all six categories of drugs,” Bloomberg found, “list prices rose far faster than inflation.”

They report:

“Prices for 10 commonly used diabetes drugs rose 25.6 percent, on average, while average prices for rheumatoid arthritis and other autoimmune treatments rose 40.1 percent. The latter category…

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Dr. Marc Siegel: Diabetes and America – We can’t afford more deaths because of rising insulin prices

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Dr. Marc Siegel: Diabetes and America – We can’t afford more deaths because of rising insulin prices

More than 30 million Americans – over 9 percent of the U.S. population – have diabetes. Over 7 million of them use insulin, which is skyrocketing in price and creating a public health crisis that will lead to needless deaths and billions of dollars of avoidable health care costs.

Out-of-control diabetes causes devastating problems to every organ in the body – including the eyes, the nerves, the kidneys and the heart.

And now some people using insulin are suffering devastating financial problems as well.

GLOBAL DIABETES EPIDEMIC DRIVES SURGE IN INSULIN DEMAND

As insulin continues to become more and more expensive, many people with diabetes who require it can’t afford it and find they have to ration its use. Tragically, news reports say some people have even died because they’ve reduced their expensive insulin dose to save money.

According to the Centers for Disease Control, in addition to the over 30 million diabetics in the U.S., another 84 million Americans have pre-diabetes, a condition that can lead to diabetes in five years.

Of the 30 million diabetics in the U.S., only about 1.25 million have Type 1 diabetes – an immune system disorder in which your pancreas…

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J&J raises US prices on around two dozen drugs

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J&J raises US prices on around two dozen drugs

Johnson & Johnson raised US prices on around two dozen prescription drugs, including the psoriasis treatment Stelara, prostate cancer drug Zytiga and blood thinner Xarelto, all among its top-selling products.

J&J joined many other companies that raised US prices on hundreds of prescription medicines earlier this month.

Most of the J&J increases were between 6 percent and 7 percent, according to data from Rx Savings Solutions, which helps health plans and employers seek lower cost prescription medicines.

The increases came on the same day that Democratic members of Congress introduced proposed legislation aimed at lowering the cost of prescription drugs for American consumers.

J&J said the average list price increase on its drugs will be 4.2 percent this year. However, it expects the net price it actually receives for its medicines to drop. That is because drugmakers negotiate rebates and discounts off the list price with payers in order to ensure patient access to their products.

The company does not plan to raise prices on any more drugs this year, J&J spokesman Ernie Knewitz said.

Drugmakers kicked off 2019 with US price increases on more than 250 prescription medicines by Jan. 2. That total has almost doubled, with pharmaceutical companies hiking prices on…

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USA: bipartisan interest in reducing medicine prices may lead to legislative action from January 2019

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USA: bipartisan interest in reducing medicine prices may lead to legislative action from January 2019

In January, Democrats will hold the majority in the House, dealing a crushing blow to much of the legislative agenda advanced by President Trump and Republicans on Capitol Hill.

But a divided Congress, with Democrats holding a majority in the House and Republicans maintaining control in the Senate, means that any legislation that can pass must be bipartisan.

The parties are far apart on a range of hot-button issues, from immigration and taxes to energy. But there is a bipartisan interest in reducing drug prices and the stars may be aligning in January for some legislative action.

This issue is not new for Mr. Trump, who campaigned in 2016 on reducing drug prices. This past May, he gave a major speech on the issue, detailing what his administration has done so far, including approving more than 1,000 low-cost generic drugs through the Food and Drug Administration and reforming the Drug Discount Program for seniors. Together, the White House says these steps have already saved more than $9 billion.

But the administration is not done.

The administration is now proposing a rule requiring drug companies to disclose the list price of prescription medicine on their TV ads. The pharmaceutical industry is opposing this effort, arguing…

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USA: Pharma innovation is stuck in an “old 1980s payment model”

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USA: Pharma innovation is stuck in an “old 1980s payment model”

Rising drug prices, industry profits, and patient access to new cures have become polarizing issues as healthcare moves to a value-based framework for reimbursement. President Donald Trump has suggested that drug companies be required to reveal list prices for any drug advertised directly to consumers. While the goal of transparency is laudable, simply providing the list price, or even a price based on average payment for insured vs. uninsured patients, would be far too simplistic a solution, panelists agreed during “Making Medicines Affordable,” a discussion at the 2018 Galien Foundation Forum in New York City on Oct. 25, 2018.  The program brought together representatives from each key biopharma stakeholder group—venture capital, small innovator, Big Pharma, insurance company, and government—to share their different perspectives.

Panelists emphasized the importance of evidence-based medicine and establishing the value of each new therapy, and also getting to know payer groups and reaching out to them as early as possible.  As Kent Rogers, senior vice-president, industry relations, with United Health Group, Inc., asked the audience, “How well do you know who will be paying for your treatments?”

He suggested broadening concerns beyond issues of efficacy and safety to include questions of reimbursement. “Consider yourself as a patient, a parent, a…

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Leverage, Transparency, and Competition suggested goals for lowering drug prices in the U.S

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Leverage, Transparency, and Competition suggested goals for lowering drug prices in the U.S

The issue isn’t new: Drug prices in the U.S. keep going up. Manufacturers justify these increases based on the high price of R&D, pharmacy benefit managers (PBMs) negotiate rebates while pocketing a large percentage of the savings, and insurers pass down costs to patients via higher deductibles and copays.

As more innovative and expensive therapies enter the market, the issue of affordability vs. value—both on an individual and system-wide level—has taken on a new urgency. While related, they are not the same. A medicine can be “worth it,” in terms of eventual cost-savings and effects on patients, but if a patient or health system can’t afford it, “it doesn’t matter how much it’s worth,” said Gary Pisano, a professor at Harvard Business School.

Pisano was one of five panelists who convened to discuss strategies for “making medicines affordable” at the 2018 Galien Forum, which was held in New York in October.

While the panelists brought a variety of perspectives and suggestions to the table, more than anything else, the discussion highlighted just how far the U.S. is from implementing a solution.

Below are three potential big-picture goals to strive for, nonetheless.

Leverage. There’s been a lot of discussion around why…

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Formularies at PMBs and health insurance companies may now change with 60% price cut in Amgen’s Repatha

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Formularies at PMBs and health insurance companies may now change with 60% price cut in Amgen’s Repatha

We wrote last week about a major price-cut announcement from a leading U.S. based biotechnology company—a move that fits perfectly with the Trump administration’s agenda of reducing drug prices and particularly lowering out-of-pocket costs to consumers through free-market competition.

But the news that Amgen was cutting the list price by 60% of one of its newest biologics, Repatha, got buried in the avalanche of news coverage about the administration’s own plans to try to use the levers of government control to force the reduction of Medicare prices for many drugs administered by physicians. This feels like an alternative universe. (More on that in a subsequent post.)

Amgen announced it was immediately making Repatha available at a reduced list price of $5,850 a year, down from about $14,500 a year, saying the move “will improve affordability by lowering patient copays, especially for Medicare patients.”

Repatha treats patients who have excessively high levels of cholesterol, including those who do not respond to traditional statins, and who therefore are at a high risk of heart attacks and strokes. It is a new class of PCSK9 inhibitors that dramatically lower cholesterol levels in patients.

By creating new, significantly lower list pricing, patients who pay a share of…

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The mid-term elections in the US may usher new drug-pricing reforms

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The mid-term elections in the US may usher new drug-pricing reforms

HOW THE MIDTERMS COULD IMPACT PHARMA — As you’ve probably heard, voters across the United States of America head to the polls Tuesday, and could shake up the power structure of Congress. Most interesting to us is what could flow from a Democratic takeover of the House coupled with continued Republican control of the Senate. That dynamic could up the chances for drug-pricing reform, one of the most significant areas where President Donald Trump has signaled he might reach across the aisle.

Big vs. little stuff: That doesn’t mean we should expect a big breakthrough on, say, negotiating drug prices in Medicare. But impactful incremental reforms, like increasing transparency around drugmakers’ relationships with pharmacy benefit managers to ensure there is no collusion to keep prices high, could get bipartisan support. The expansive Medicare Part B drug payment pilot that HHS rolled out two weeks ago also is likely to get more support from congressional Democrats than Republicans. Refresh your memory on the landscape for drug pricing collaboration with this story for Pros here.

Despite the long odds, Democrats won’t give up without a fight on bold moves like government negotiation of drug prices, which Trump supported on the campaign trail…

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