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Underwater: Medicare Negotiated Prices For Part B Cancer Drugs Could Change Prescribing

 
• By Cathy Kelly

Anticipation that reimbursement for significantly discounted Keytruda and Opdivo won’t keep them afloat will influence treatment decisions by oncology providers, officials predict.

Oncology Practices Worry Reimbursement Won't Cover Costs • Source: Shutterstock

Medicare price negotiation for Part B oncology drugs will have ramifications across Medicare and commercial insurance markets because of the way that reimbursement works for physician-administered drugs, experts predicted at the Association of Value-Based Cancer Care educational summit on 18 October.

Practices are already thinking about shifting prescribing to a non-negotiated therapeutic equivalents or referring patients to hospitals for treatment if they lose too much money on reimbursement for drugs targeted by the government price setting process

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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

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

 
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New draft guidance on the third cycle of Medicare drug price negotiations goes against Merck and BMS expectations for their cancer drugs.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

 
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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New draft guidance on the third cycle of Medicare drug price negotiations goes against Merck and BMS expectations for their cancer drugs.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.