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CMS’ Likely Reversal Of Threat To Part D Protected Classes Doesn’t Mean Other Reforms Aren’t Coming

 
• By Cathy Kelly

Concerns about reducing patient protections will resonate with the Biden Administration and the Medicare Part D protected classes aren’t major cost drivers anyway, Avalere’s Mendelson says.

Patient Concerns Will Probably Thwart Efforts To Restrict Protected Classes Again

The Centers for Medicare and Medicaid Services is likely to consent to pleas from patient groups and others to reverse a Trump Administration policy that would allow Medicare Part D plans participating in a payment demonstration project to cover only one drug in the protected classes beginning in 2022, essentially waiving the “substantially all” coverage requirement for the purposes of the experiment.

The change, made on the final day of the Trump Administration, was meant to attract more participation in the Medicare Modernization demonstration, which is being conducted under the auspices of...

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More from Medicare

Will International Prices Influence Medicare Price Negotiation?

 
• By Cathy Kelly

A former CMS official suggested the most likely way it could happen is through a Center for Medicare and Medicaid Innovation demonstration.

Industry Leaders Grapple With Trump’s Most Favored Nation Pricing Plan

 
• By Jessica Merrill

At the Bank of America health care conference, pharma leaders speculated on the impact of Trump’s most favored nation pricing executive order on US and European markets.

New Guidance Suggests SubQ Keytruda, Opdivo Formulations May Not Avoid Medicare Negotiations

 
• By Sarah Karlin-Smith

New draft guidance on the third cycle of Medicare drug price negotiations goes against Merck and BMS expectations for their cancer drugs. The guidance also tackles Part B and renegotiated prices for the first time.

House Budget Bill Includes Delayed Orphan Fix, Also Risks Downstream Cell and Gene Coverage

 
• By Sarah Karlin-Smith

The first two classes of negotiated drugs under the Inflation Reduction Act would not benefit from a rare disease adjustment House Republicans included in their reconciliation package.

More from Government Payers

New Guidance Suggests SubQ Keytruda, Opdivo Formulations May Not Avoid Medicare Negotiations

 
• By Sarah Karlin-Smith

New draft guidance on the third cycle of Medicare drug price negotiations goes against Merck and BMS expectations for their cancer drugs. The guidance also tackles Part B and renegotiated prices for the first time.

House Budget Bill Includes Delayed Orphan Fix, Also Risks Downstream Cell and Gene Coverage

 
• By Sarah Karlin-Smith

The first two classes of negotiated drugs under the Inflation Reduction Act would not benefit from a rare disease adjustment House Republicans included in their reconciliation package.

Trump’s Rx Pricing Order: The Best-Case And Worst-Case Scenarios

 
• By Derrick Gingery

US trade and tariff leverage might successfully push European and other countries to pay more for medicines, but if not, President Trump’s executive order includes potential US drug withdrawal and other options to entice industry to lower US prices.