Medicaid
The sales opportunity in Medicare Part D and Medicaid arrives as Lilly and Novo Nordisk face a new competitive threat from compounded semaglutide for obesity.
The HHS OIG advisory pertains to manufacturer sales to patients. OIG will seek stakeholder input regarding possible additional guidance on manufacturer arrangements with pharmacies, pharmacy benefit managers, telemedicine vendors and marketers.
BMS's Lenkowsky discussed the impact of the company's MFN deal in an interview at the J.P. Morgan Healthcare conference.
The plan does not include many details, but is intended to help Congress draft legislation ensuring Most Favored Nation drug pricing agreements can be made, as well as implement measures intended to lower insurance premiums.
The announced agreement means AbbVie and Regeneron are the only companies of the 17 notified by the White House in July yet to make a deal.
The agency is considering setting a payer participation ‘threshold’ to meet before the model goes into effect.
The US Centers for Medicare and Medicaid Services argued gender affirming care is not health care to help justify the new proposed rules. The argument could create a new opening for the federal government to go after other pharmaceuticals.
Manufacturers are responding to a convergence of factors, but plans will miss the rebate dollars they have relied on in the current pricing model.
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.