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Drug Pricing

April 13, 2018 | Daily News

FDA Commissioner Scott Gottlieb again attacked plans for high drug costs, and he honed his explanation for taking on policies under CMS’ purview.

April 12, 2018 | Daily News

House Ways & Means health subcommittee Chair Peter Roskam (R-IL) opposes making plans share rebates with seniors when they buy drugs at the pharmacy, a spokesperson for the committee said in response to an Inside Health Policy article stating that Roskam is warming to the idea.

April 11, 2018 | Daily News

House Ways & Means health subcommittee Chair Peter Roskam (R-IL) is now open to making plans factor in rebates and pharmacy price concessions at the point of sale, and drug makers and pharmacists in separate meetings this week urged CMS to adopt that approach after the agency said it has the power to do so.

April 10, 2018 | Daily News

State pharmacy associations, led by the National Community Pharmacists Association, are urging the Senate Judiciary Committee to hold a hearing on pharmacy benefit managers and proposed mergers between PBMs and insurers.

April 10, 2018 | Daily News

CMS reduced what low-income beneficiaries pay for biosimilars to the level of generic drug cost-sharing, but the agency changed how it accomplished that goal in the Part D final rule due to brand drug makers' concerns.

April 10, 2018 | Daily News

The Association for Accessible Medicines released Monday (April 9) a new code of ethics which attempts to differentiate the generic drug industry's principles from those of its brand counterpart by focusing on product access. AAM, however, steers clear of imposing any limits on the prices its members can set for their drugs.

April 06, 2018 | Daily News

House Energy & Commerce ranking Democrat Frank Pallone (NJ) asked CMS why the agency's drug spending dashboards haven't been updated since President Trump took office, and said that lack of transparency on Medicare and Medicaid spending calls into question Trump's commitment to lower drug prices.

April 05, 2018 | Daily News

Ohio banned gag orders that plans and pharmacy benefit managers use to prevent pharmacies from telling customers when it is cheaper to buy drugs without using their insurance.

April 04, 2018 | Daily News

CMS officials maintain that they can require plans to share rebates and pharmacy price concessions with beneficiaries at the pharmacy counter, and Administrator Seema Verma said Monday (April 2) that policy is still being considered but declined to say when CMS will decide whether to propose such a rule.

April 03, 2018 | Daily News

Hospital groups asked a federal appeals court on Monday (April 2) to effectively mandate HHS increase pay for 340B hospitals in the 2019 outpatient pay rule to make up for what the group alleges are illegal cuts to Medicare reimbursement for 340B drugs in the 2018 version of the rule.

April 03, 2018 | Daily News

CMS officials criticize the new budget law for making brand drug makers pay 70 percent of Part D donut-hole costs while plans cover 5 percent of those beneficiary costs.

April 02, 2018 | Daily News

Medicare Advantage plan revenues next year will increase 3.4 percent, plus 3.1 percent in revenue from coding changes, thanks in large part to the Bipartisan Budget Act, CMS estimates.

April 02, 2018 | Daily News

CMS says Medicare Advantage plans that contract directly with hospitals can negotiate the rates they pay those providers for 340B drugs and the agency can't interfere, but if plans are paying hospitals that don't have a contract, then the hospitals must receive original Medicare rates -- which as of January include lower reimbursement for 340B drugs.

April 02, 2018 | Daily News

Three senators are probing Tri-Source Pharma over the company's decision to hike the price of its cancer drug, lomustine, by 1,400 percent since 2013.

March 29, 2018 | Daily News

The same day that the head of FDA attacked pharmacy benefit managers for high drug prices, HHS Secretary Alex Azar announced Thursday (March 29) that an executive of a big-three PBM will lead drug-price policy.

March 28, 2018 | Daily News

The pharmacy benefit manager lobby says FDA Commissioner Scott Gottlieb was wrong to say PBMs collude with brand drug companies to use Risk Evaluation and Mitigation Strategies to block generic competition.

March 27, 2018 | Daily News

HHS Secretary Alex Azar and CMS officials are leaning against letting Massachusetts use closed formularies to negotiate cheaper brand drug prices in Medicaid, lobbyists following the MassHealth proposed waiver said.

March 27, 2018 | Daily News

Brand drug makers for the first time agreed to banning so-called pay-for-delay settlements to pay for lowering their share of Medicare Part D coverage-gap costs, and that acquiescence during the omnibus appropriations negotiations makes it easier for Congress to use the policy as an offset for other health care priorities in the future, brand and generic lobbyists said.

March 22, 2018 | Daily News

The CMS review of one of the first alternative pay models to be recommended by an independent outside organization is moving along swiftly, CMS Administrator Seema Verma said Thursday (March 22), and the agency plans to help doctors deal with restrictions against self-referrals that providers say impede alternative payment model development.

March 20, 2018 | Daily News

Omnibus appropriations legislation is no longer expected to lower brand drug makers’ share of Part D coverage-gap costs, congressional staff and brand drug lobbyists say, but generic drug lobbyists say the brand-backed Part D measure has a good chance of being included along with a ban on so-called pay-for-delay settlements that generic drug makers oppose.