Drug Pricing

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.

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.

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.

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.

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.

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.

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.

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.

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.