1. Pink Sheet
  2. >>Market Access
  3. >>Government Payers
  4. >>Medicare

Medicare Part D Protected Classes Targeted in Last-Minute Payment Demo Update

 
• By Cathy Kelly

If not reversed by the Biden Administration, demo program that puts plans at increased risk in catastrophic phase would also enhance negotiating leverage for drugs in the protected classes.

Protected Classes Policy Is Unique To Medicare Part D

The Centers for Medicare and Medicaid Services announced on the final day of the Trump Administration that it would allow insurers participating in the Medicare Part D payment modernization model to restrict coverage in the six protected classes, in an attempt to attract more volunteers to the demonstration.

Under an eleventh-hour update to the model released on 19 January, CMS announced it would waive the requirement that...

Read the full article – start your free trial today!

Join thousands of industry professionals who rely on Pink Sheet for daily insights

  • Start your 7-day free trial
  • Explore trusted news, analysis, and insights
  • Access comprehensive global coverage
  • Enjoy instant access – no credit card required
Start Free Trial

Already a subscriber?

More from Medicare

Medicare Part D Plans Turn to Coinsurance, Higher Deductibles Amid IRA Changes

 
• By Tim Casey

Newly implemented IRA provisions may not necessarily lower drug costs for those enrolled in Medicare Part D plans, according to research by the USC Schaeffer Center for Health Policy and Economics.

US Pricing Reform: New Products Offer ‘On Ramp’ To Implementation, Lilly’s Ricks Says

 
• By Cathy Kelly

Eli Lilly's CEO argued that pricing reforms aimed at existing drugs would be “hard to sustain or justify,” while other companies suggested a growing interest in direct-to-consumer sales programs.

Pharma Cooperating With Trump On Direct Sale To Consumers, Pfizer CEO Says

 
• By Jessica Merrill

Pfizer is in active discussions with Trump on MFN pricing and collaborating with peers on direct sales as an approach to lower drug prices, CEO Albert Bourla said.

Cuban: Drugmakers Are More Afraid of PBMs Than Trump

 
• By Leslie Small

The billionaire investor said during a recent conference that brand drug manufacturers want to work with his Cost Plus Drug Co., but are afraid the PBMs will retaliate.

More from Government Payers

Japan To Cut Leqembi Price By 15% Following Cost Effectiveness Review

 
• By Lisa Takagi

While Japanese government announces 8-15% price cuts for four drugs, including Leqembi, industry groups urge operational improvements to national cost effectiveness assessment scheme.

Dutch HTA Calls For “Socially Acceptable” Price For Gene Editing Therapy Casgevy

 
• By Francesca Bruce

Vertex and Biogen are working with the Dutch government to ensure access for eligible patients.

Lilly’s Price Deal For Mounjaro In UK A Harbinger Of The MFN Future?

 
• By Cathy Kelly

The arrangement, which implies a behind the scenes negotiated discount, may signal a trend toward less price transparency in foreign markets as manufacturers parry Trump’s Most Favored Nation price demands.