Pricing Debate
CMS backs off on a plan to put “guardrails” around manufacturer payments that are excluded from Average Sales Price calculations in Medicare, but is planning to revisit the issue.
CMS may have decided some of the IPAY 2027 drugs did not measure up to their IPAY 2026 therapeutic alternatives, but negotiation parameters also may have played a role in the lower prices negotiated in the latest round compared to the first cycle.
The final guidance for the upcoming third round of the Medicare drug price negotiation process is most notable for the amount left unchanged.
South Korea has laid out comprehensive drug pricing reforms that aim to enhance patient access to treatment, accelerate innovation and stabilize essential drug supplies, but the industry is concerned it could lead to weaker R&D and manufacturing and increased dependency on high-priced imports.
Under the newly-announced UK-US trade deal, the UK will increase the thresholds used to evaluate the cost-effectiveness of new medicines, which should allow higher prices for innovative therapies.
The Medicare negotiated price is slightly higher than the Most Favored Nation price recently announced by the Trump Administration.
Because they are not heavily rebated already, the discounts on four cancer treatments and a trio of other specialty drugs may benefit patients and the government more than others in the IPAY 2027 class.
While Japan tries to balance its healthcare costs, the major US industry group is concerned reimbursement pricing practices in the country could influence US levels under Trump's MFN policy.
The pharmaceutical industry has been pushing back on a deeply unpopular rebate on products deemed to be “free combination” medicines in Germany.
With UK chancellor Rachel Reeves set to deliver the country’s budget on Wednesday, Medicines UK has set out five “focus areas” where the off-patent industry believes that action is needed.
The inclusion of Medicare Part B drugs in the program for the first time will sweep in several biologics, even though heavy hitters Keytruda and Opdivo will not be among them.
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.
The deadline by which pharma companies must decide whether they want to leave the UK’s voluntary pricing scheme for branded medicines has been extended to mid-December – meaning that for the first time, companies can find out the terms of the scheme before opting in or out.
Demonstration could bring unprecedented transparency into international net prices, at least to CMS.
Sam Roberts, chief executive of England’s NICE, has defended the health technology assessment institute’s cost-effectiveness thresholds and the country’s ranking against other nations when it comes to market access, while acknowledging that the UK’s pharma ecosystem is “really tough.”
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.
China’s NHSA expects to release the first list of innovative drugs to be covered by commercial health insurance in early December, but implementation, payment collection and data sharing are expected to be among the main hurdles ahead.
HRSA releases finalized plans for the 340B rebate model pilot program, but does not change its position on when manufacturers may deny 340B rebates because of duplicate discounts.
Industry watchers are skeptical about broad uptake of the model, but Cigna aims to enroll 50% of fully-ensured employer plans in its first year of broad availability.
CMS official John Brooks said CMS cannot undo plans to publish MFPs and not average sales prices for physician-administered drugs in the Medicare price negotiation program. But he suggested the agency could modify its approach related to bona fide service fees and ASPs.