Paragon Health Institute’s Post

There is a major discussion happening now in the US regarding Medicare's ability to do price negotiations. The NY Times has jumped into the discussion with this article on Counterarguments to this new policy. What do you think? Will this help patients, hurt patients or neutral? Is this the start of a more comprehensive approach to drug pricing in the US or a one-off effort by Medicare? https://lnkd.in/eHQTb2Gt #heor #medicare #dataanalytics

Medicare drug price negotiation factsheet and timeline, good read

Has your organization began looking at the 2024 PUF files to see how Part D sponsors have begun positioning themselves for IRA changes? The changes in the standalone PDP market are insightful. Check out this paper where our Oliver Wyman Medicare team has looked at this in detail. #medicareadvantage #medicare #OWActuarial #inflationreductionact

Next Friday is the first deadline for Medicare to release the 10 drugs that will be subject to active price negotiations between the government and manufacturers. I have so many feelings! And so many questions! How "active" will the negotiations be? Is "take it or leave" a "fair" way for the government to negotiate prices? Was that the intent of congress, or perhaps I'm misunderstanding the law? I also don't understand constitutional law. Is charging obscene amounts for drugs and health care protected under the first amendment? Is the Bill of Rights the reason why drug costs are 3x higher in the US than Europe? Will the Supreme Court delay this program? Enjoy some reading below if you're interested! https://lnkd.in/gmYDZ9Y2 Timeline https://lnkd.in/gQVdm5HN CMS Webpage https://lnkd.in/gH6iAU5G News Article https://lnkd.in/gKcbMaS5 Lawsuit

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

The industry is still a few years away from knowing the full impact that the Inflation Reduction Act will have on drug prices. But some critical provisions have already impacted drug plan sponsors for 2024. Our team has identified five areas that Medicare Advantage plans should consider when shaping their 2025 Part D strategy > https://owy.mn/47fU7EF #OWActuarial #Medicare #MedicareAdvantage

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

"For many Americans, the cost of one drug is the difference between life and death, dignity and dependence, hope and fear." In fact, more than 60% of the 65 million people on Medicare take prescription medication, and 25% take at least four prescriptions a day. The Medicare Drug Price Negotiation Program is the latest effort to combat rising health care costs. Read our blog post below to learn which drugs are first in the negotiations and when we will see lowered prices. #healthcarecosts #healthinsurance #insuranceadministration

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

Last month, the Centers for Medicare & Medicaid Services named the first ten drugs that will be subject to price negotiation as part of the #IRA. Ashley Jaksa, Market Access Scientific Strategy Lead at Aetion, spoke with The Evidence Base® about how the predictions around this list ultimately played out and the value of quality #RWE for future Medicare drug pricing negotiations. Read the full feature here: https://bit.ly/45Hjsaw.