In the year ahead, Trump administration drug pricing policies
are likely to be changed or revoked by the incoming Biden administration and
court challenges, although which policies will be affected — and to what extent
— is still unclear, policy experts tell AIS Health.
Brian Anderson, a principal at Milliman Inc., observes that
firms have to act as though they will need to comply with the Trump
administration's rules, even if there is consensus that the new administration
will make changes.
Anderson says that plans and PBMs are also just beginning to
make sense of a provision in the Consolidated Appropriations Act, 2021, the
pandemic relief and omnibus spending bill passed by Congress on Dec. 21, 2020,
which requires increased reporting on drug prices by plans to HHS, and the
Labor and Treasury departments.
The Biden administration has not yet made clear which Trump
regulations it will revise or eliminate. But PBMs aren't waiting to find out:
The Pharmaceutical Care Management Association (PCMA) filed a lawsuit on Jan.
12 seeking to overturn the so-called rebate rule, which the Trump
administration finalized on Nov 20.
It's an open question whether the Biden administration will make
substantive changes to the rule, or even defend it in court, according to Ge
Bai, Ph.D., a professor at the Johns Hopkins Carey Business School who studies
health care finance.
"I don't have a take on whether Biden will continue on with
the rebate rule," Bai tells AIS Health. "The biggest problem is that
premiums will increase. So that is the hurdle for the future implementation of
this rule. But on the other hand, the benefit is that the patient is absolutely
going to see savings at the pharmacy counter."
Generally speaking, Bai says that PBMs are facing much more
political scrutiny than they have in the past.
Dan Mendelson, founder of consultancy Avalere Health, says that
increased awareness of PBMs' role in drug pricing has mainly attracted the
attention of state legislators so far, and therefore state-level action on PBMs
is "more likely" than aggressive moves by Congress. But Mendelson
predicts that could change if Congress makes the big push on health care reform
that progressives hope for.
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