Jun 4, 2018
While PBMs and health
insurers took exception to some of the ideas in President Trump’s blueprint to
lower drug prices, analysts say those industries have few reasons to worry
about the near-term initiatives proposed.
The two
immediate-action proposals that are most relevant for MCOs and PBMs are largely
positive, according to Credit Suisse analyst A.J. Rice. He adds that one of
those proposals — allowing Part D plans to adjust their formulary or benefit
design during the benefit year to address price increases for single-source
generic drugs — could further improve visibility over the medical cost trend.
The concept of
identifying drugs in Part B where there are savings to be gained by moving them
to Part D also “represents an additional opportunity for MCOs offering
Stand-alone Part D plans,” wrote Rice.
One concern for PBMs
is the administration’s statement that it will consider “measures to restrict
the use of rebates, including revisiting the safe harbor under the
Anti-Kickback statute for drug rebates.”
The Pharmaceutical
Care Management Association responded that “getting rid of rebates and other
price concessions would leave patients and payers, including Medicaid and
Medicare, at the mercy of drug manufacturer pricing strategies.”
Meanwhile, the Pharmaceutical
Research and Manufacturers of America is pushing back the idea of merging Part
B into Part D. In a May 11 statement, the group said “we must avoid changes to
Medicare Part B that could raise costs for seniors and limit their access to
lifesaving treatments.”
Furthermore, a new
analysis from Avalere points out that in 2016, average out-of-pocket costs were
about 33% higher for Part D-covered new cancer therapies than for those covered
in Part B, suggesting such a move could impact consumers.
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