Medicare ‘Maximum Fair Price’ And The Importance Of Choosing The Right Therapeutic Alternatives

The Centers for Medicare and Medicaid Services should rely on input from manufacturers, clinicians and patients when choosing therapeutic alternatives that will be used as pricing references for drugs selected for negotiation, the Pharmaceutical Research and Manufacturers of America urges in comments to the agency.

The comments respond to the CMS initial guidance on the price negotiation process. CMS said in the guidance it will begin the process of determining a “maximum fair price” by comparing selected drugs with the prices and clinical benefits of therapeutic alternatives. (Also see "Medicare Price Negotiations: Competitors’ Net Prices, Clinical Benefit Are ‘Starting Point’ For Initial Offer" - Pink Sheet, 16 March, 2023.) The comments also recommend that CMS use the minimum price discount established by law as a default price in the early years of the program