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Medicare Price Negotiations: Competitors’ Net Prices, Clinical Benefit Are ‘Starting Point’ For Initial Offer

 
• By Sarah Karlin-Smith

CMS chose the prices of therapeutic alternatives and these competitors’ comparative benefits as the ‘foundation and starting point’ for setting an initial offer for drugs subject to negotiation, ahead of other factors Congress laid out it could consider that are more singularly focused on the specific drug at issue.

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Competitor pricing may influence CMS drug price negotiations more than manufacturer-provided data, per new guidance • Source: Shutterstock

The net prices and clinical benefit of therapeutic alternatives will be critical starting points for the Centers for Medicare and Medicaid Services as it looks to craft initial offers for the first set of drugs selected for US government price negotiations.

CMS outlined the methodology for developing an initial offer in draft guidance released on 15 March. The guidance describes...

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