Patients and patient advocates raised a potentially concerning paradox at the first Medicare public listening session on the drugs that will be subject to US government price negotiations under the new Inflation Reduction Act – that the government’s ability to get lower list prices for selected drugs might lead pharmacy benefits managers to make the medications more inaccessible to patients.
Could Government Negotiated Prices Curtail Access? PBMs And Potential Perverse Incentives Dominate First Medicare Listening Session
Patients and advocacy groups tell Medicare they want lower cost drugs but are concerned that if government negotiations lower list prices, rebate-focused PBMs may preference higher list-price competitors.
More from Pricing Debate
• By
A Republican think tank suggested variations of the Most Favored Nation and international reference policies in Medicare and Medicaid, as well as tariffs and other trade levers to rebalance drug pricing disparities between US countries and abroad.
• By
Democrats opposed the nomination because they believe Mehmet Oz will not defend Medicaid from spending cuts. His pledge to continue lowering drug costs in Medicare and Medicaid did not offset the concerns.
• By
The UK branded drug industry is calling for adjustments to be made to the UK voluntary scheme framework for branded medicines, after the payment rate increased to 22.9% for 2025. Meanwhile, the generics industry says the scheme is functioning “as intended” and opposes any changes.
• By
An initiative run by health technology appraisal (HTA) bodies in the US, Canada and England is looking at how non-traditional treatment benefits, such as the value of hope and scientific spillover, can inform appraisals and understanding of a product’s value.
More from Market Access
• By
Experts say PBMs should become familiar with transparency rules and prepare to release data, although more legal wrangling could occur.
• By
Optum Rx, one of the largest PBMs in the US, declared it was the “first comprehensive, transparent pharmacy services company” after announcing several consumer-friendly changes.
• By
Health technology assessment body NICE said it has taken on feedback about the implications of allowing higher cost-effectiveness thresholds for some medicines after senior health economists offered diverging views on its methods.