Medicaid
The Trump Administration’s formula for ‘Most Favored Nation’ pharmaceutical pricing has evolved since the first Trump team proposed MFN pricing for Medicare in 2020. The ‘GENEROUS’ Medicaid model in 2025 is indeed more generous to manufacturers – though still not an attractive proposition.
Demonstration could bring unprecedented transparency into international net prices, at least to CMS.
The $245 price agreed to by both firms may be in line with the maximum fair price that Medicare negotiated for Novo Nordisk’s semaglutide products.
The Trump Administration’s efforts to encourage more US-based pharmaceutical manufacturing have largely centered on FDA plans and Trump’s threats of tariffs and Most Favored Nation pricing, but Oz hinted Medicare and Medicaid soon may soon announce new incentives.
John Brooks, who is a lead negotiator on Most Favored Nation pricing commitments, said manufacturers must present a united front in order to narrow the gap between US and foreign drug prices.
Pink Sheet reporter and editors discuss the FDA’s role in the Astra Zeneca Most Favored Nation drug pricing deal and the Justice Department interpreting the off-label promotion laws differently than the FDA.
A combination of two individual IVF treatments, Pergoveris has the potential to be a lower cost option in the US, one of the qualifications the FDA wants in a National Commissioner's Priority Voucher candidate.
Pfizer and AstraZeneca must be confident that drug price reductions in Medicaid and through direct-to-consumer channels will not lead to deeper discounts in the 340B program.
AAM and the Biosimilars Forum criticized a rule adopted by Colorado’s Prescription Drug Affordability Board to establish an upper payment limit for Enbrel well before market entry for etanercept biosimilars.
Most drug companies generate about half of US revenues from non-commercial market sources, including Medicare, Medicaid, other government programs like the Veterans Affairs Department or the cash pay market.
Marty Makary's role in helping negotiate the Trump Administration's second "most favored nations" drug pricing deal is raising concerns as the Trump team has suggested it would use drug pricing as a lever to impact FDA approval status or speed of drug reviews.
CMS Administrator Oz punted on a GLP-1 question in an interview, suggesting it was because his agency will be acting soon.
The company’s agreement with the Trump Administration, which likely is a template for MFN deals with other companies, also includes a $70bn commitment to ‘reshoring’ development and manufacturing in the US.
The company is referring Medicaid patients to an “enhanced” patient assistance program to retain access to the drug.
The US Supreme Court ruled the Affordable Care Act’s preventive care coverage mandate is constitutional, but HHS Secretary Robert F. Kennedy Jr. may have gained more power over what is classified as preventive care.
Eli Lilly's CEO argued that pricing reforms aimed at existing drugs would be “hard to sustain or justify,” while other companies suggested a growing interest in direct-to-consumer sales programs.
Pfizer is in active discussions with Trump on MFN pricing and collaborating with peers on direct sales as an approach to lower drug prices, CEO Albert Bourla said.
The billionaire investor said during a recent conference that brand drug manufacturers want to work with his Cost Plus Drug Co., but are afraid the PBMs will retaliate.
The new 60-day deadline for striking a deal with the drug industry underscores the challenges the Administration may be having in developing non-voluntary policies to achieve MFN pricing in the US.
Pilot is harbinger of greater transparency in the 340B program. But rebates may only be denied by manufacturers for overlap with Medicare negotiated prices, not for issues like diversion that have driven recent lawsuits.