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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