Aetion’s Post

"Unveiling the Veil: OIG Investigates the Price Impact of Integrated Medicare Plans and Pharmacy Benefit Managers". The Office of Inspector General is investigating how integrated Medicare plans and pharmacy benefit managers influence drug prices, responding to concerns raied by senators. With findings expected by 2026, this probe seeks clarity on pricing practices amidst vertical integration. #pbm #pharmacymanagement #medicare #oversight #drugpricing

One of the many objectives of the Inflation Reduction Act is to lower prescription drug costs and increase access to life-saving medications. But defining access continues to be a challenge. In preparation for drug negotiations with Medicare, today Centers for Medicare & Medicaid Services held the first of many listening sessions with patients and patient advocates. The goal being to provide patients with a venue for Medicare to understand patient's daily life dealing with their conditions and their thoughts on the value of therapeutic alternatives. I had the opportunity to listen to today’s opening session with CMS for apixaban/Eliquis, one of the ten drugs selected for negotiation for 2026. Unsurprisingly, one of the key themes from today’s speakers were their issues and concerns over continued access to their medications and the healthcare system in general. Concerns over formulary management becoming more demanding, confusion on financial assistance, issues with preferred pharmacy networks, worries over access in rural communities, and issues with basic enrollment in health plans. I commend the CMS for this first of many sessions to better define the situation at hand. However, we must recognize that these listening sessions are only continuing to bring to light the challenges that patients have accessing healthcare. #marketaccess #patientaccess #inflationreductionact #medicare #formulary

🚩As CMS prepares to send its initial drug pricing offers under the IRA by Feb 1, it’s clear that the shift towards government price controls in Medicare Part D risks unintended but foreseeable harms to innovation & patient care. Read more on the issue ⬇️

Following CMS's announcement of the first 10 drugs targeted for #Medicare price negotiations, #AvalereExpert Kelsey Lang spoke with MedPage Today about what is behind discrepancies between experts' list predictions and the published list: https://lnkd.in/ejbRZnHT Read more about Kelsey and other #IRA implementation experts' take on the announcement here: https://lnkd.in/ePp3TqeN #drugpricing #InflationReductionAct

CMS publicly released the 2024 Medicare Star Rating data, including the Star Rating Technical Notes, on Friday, October 13th. This data summarizes how Medicare Advantage Organizations (MAOs) performed on various quality measures during the 2022 measurement year and serves as an indication of changing Medicare Advantage spending in 2025 due to changes in Medicare Advantage Prescription Drug (MA-PD) Overall Star Ratings. The publication of the 2024 Star Rating Technical Notes allow for analysis of the measure-level cut points changes. This paper analyzes the latest cut point changes to understand how the Tukey Outlier Deletion methodology and changes in the overall quality performance have impacted Star Rating cut points. Featured Authors: Suzanna-Grace Tritt & Lisa Winters #Medicare #Stars #Ratings #PartD #MedicareAdvantage #MedicareStars #MAPD #CMS #StarRatings #PartCandDStarRatings

Medicare drug price negotiation is benefitting you. Look at the savings in your home state: https://lnkd.in/g7z3dcHQ

Few domestic political decisions have a substantial impact on the future of our country. The Biden Administration's decision to move forward with Medicare drug pricing negotiations is one of them. This is a decision that the previous administration also supported. Learn more about the U.S.'s negotiation over drug pricing here: https://lnkd.in/ezpBHMP9

Talked to HHS Secretary Xavier Becerra for my latest story—all 10 drugmakers with drugs selected for the Medicare Drug Price Negotiation Program have agreed to participate. That means the negotiation process can now begin, Becerra told me. The program, which was created under the 2022 Inflation Reduction Act,  is intended to lower the cost of some of the most popular and expensive drugs in Medicare. Read more: #medicare #drugprices #HHS #drugpricenegotiation

It has been almost two years since the Inflation Reduction Act (IRA) was implemented. To keep our clients informed, our PBMs & Pharmacies practice regularly publishes updates on the spectrum of IRA developments impacting the health care industry. In the 2024 Q1 update, the Mintz team dives into the following topics: 1. The status of the negotiations between CMS and manufacturers due to the Medicare Drug Price Negotiation Program. 2. Drug pricing and related IRA initiatives, including Medicare Part D benefit design changes and the inflation rebate programs under Medicare Parts B and D. 3. Current legal challenges against the Negotiation Program. 4. An overview of the IRA’s small biotech exemption and more. https://bit.ly/3SIsdeY

This past week, CMS held their patient listening sessions on the new Medicare Drug Price Negotiation Program under the Inflation Reduction Act. Just in time for National Diabetes Awareness Month, the session heard from many patients speakers that have used Novolog or Fiasp, one of the selected 10 drugs up for negotiation. I shared my story on how this drug, Novolog, became my lifeline seventeen years ago; and for the last seventeen years I have continued to watch the price of my insulin rise, absent of it ever changing in effectiveness, molecular composition, or delivery method. In 2026, the first ten drugs with negotiated maximum fair prices will go into effect. Approximately 763,000 Americans on Medicare Part D used Fiasp and Novolog in 2022, and the average spending was $3,323 per enrollee. The negotiations will forever change the landscape of how much is expected to be spent on insulin. This is a crucial step towards pharma accountability. The Medicare Drug Price Negotiation Program will eliminate cost sharing and cap out of pocket spending for people with Medicare Part D, require drug companies to pay a rebate to CMS if they raise their prices faster than inflation, and reduce drug spending by the federal government. In 2026, many more Americans will have access to affordable insulin. While this is not the end of the journey to #insulin4all, it is another step forward! #nationaldiabetesawarenessmonth https://lnkd.in/efBWMz9u