1. Pink Sheet
  2. >>Market Access

Medicare Part D Redesign Could Expand Rebate-Driven Formulary Exclusions In Program

 
• By Cathy Kelly

Increased application of utilization management controls expected as plans face higher costs under the redesign. However, the formulary advantages available to drugs in the protected classes may lead developers to sharpen their focus on those categories.

Formulary Exclusions Less Common In Part D Than The Commercial Market • Source: Shutterstock

Medicare Part D plans will look to tighten their management of drug costs in the next couple of years as the benefit redesign established by the Inflation Reduction Act shifts more of the financial burden of coverage from Medicare to plans.

Starting in 2025, plan responsibility for branded drug costs in the catastrophic phase will increase from the current 15% to...

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 Market Access

Pink Sheet Podcast: US FDA Changes COVID-19 Vaccine Labeling, Reimbursement Confusion Rises

 
• By Derrick Gingery, Sarah Karlin-Smith, and Sue Sutter

Pink Sheet reporter and editors discuss the US FDA’s changes to the COVID-19 vaccine indication and its revocation of the vaccine emergency use authorizations, as well as new vaccine coverage and reimbursement questions.

Colorado Board Adopts Medicare Maximum Fair Price For Enbrel, Assumes Amgen ‘Amenable’

 
• By Cathy Kelly

The state’s prescription drug affordability board could be the first to recommend an upper payment limit for a prescription drug.

MSD Works To Reverse English Funding Refusal For Winrevair; Reimbursement Plans Progress Elsewhere

 
• By Neena Brizmohun

MSD is gearing up to demonstrate the value of its pulmonary arterial hypertension drug, after England’s health technology assessment institute provisionally said the product was not cost-effective. Meanwhile, the company told the Pink Sheet about Winrevair’s reimbursement status across Europe.

China NHSA Releases Preliminary Innovative Drug List For First Time

 
• By Xu Hu

China’s NHSA in August released for the first time a preliminary list of innovative drugs under commercial insurance, along with a preliminary list of products under the National Reimbursement Drug List.

More from Pink Sheet

US FDA’s ARIA Analysis Adds Earlier Scan To Biogen/Eisai Leqembi Label

 
• By Bridget Silverman

Six deaths early in treatment inspired a new safety requirement for Biogen/Eisai’s Leqembi to promote early identification of patients affected by the well-known risk of amyloid-related imaging abnormalities with edema (ARIA-E).

COVID-19 Vaccines: Pfizer Arguments To Keep EUA Failed To Persuade US FDA’s Prasad

 
• By Sue Sutter

The CBER director rejected Pfizer’s assertions that pediatric dosing gaps, supply constraints and comparative mRNA content justify keeping the vaccine under emergency use authorization for younger children.

New US FDA AI Councils Will Focus On Internal, External Policy

 
• By Sarah Karlin-Smith

The agency is creating two new AI councils to facilitate its role in responsible AI adoption and regulation.