Drug Pricing

US Drug Prices Are 8x the Cost in Peer Countries for Some Drugs

January 5, 2024 - Despite efforts to reduce drug costs through Medicare negotiation for 10 common medications, the US still pays more for these drugs than almost any other nation, even after factoring in discounts and rebates, according to a Commonwealth Fund chartpack. The researchers used 2021 data from IQVIA and the Medicare Payment Advisory Commission (MedPAC)...

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Key Regulations and Policies That Will Impact Payers in 2024

by Victoria Bailey

As healthcare stakeholders and the federal government work to make healthcare more accessible and affordable for consumers, CMS and HHS are frequently introducing and finalizing new rules and regulations. There were a couple of key...

Drug Price Negotiation Would’ve Reduced Prices, OOP Spending in 2021

by Victoria Bailey

If the drug price negotiation program had been in effect in 2021, Part D drug prices would have fallen 63 percent and out-of-pocket spending would have declined 23 percent, research from Mathematica...

Who is Challenging the Medicare Drug Price Negotiation Rule?

by Victoria Bailey

The Medicare drug price negotiation provisions in the Inflation Reduction Act hold promising spending reductions for beneficiaries, but drug companies are not backing down without a fight. In August...

HHS Releases First 10 Drugs Eligible for Medicare Price Negotiation

by Victoria Bailey

Updated 10/3/2023: This article has been updated to include the drug companies' decisions to participate in the negotiation process. HHS has announced the first ten drugs that will be available...

Payer Turns to PBM Coupon Program to Lower Prescription Drug Spending

by Kelsey Waddill

Reducing drug prices is top-of-mind for payers and employers alike. Some payers, like Capital Blue Cross, seek to make drugs more affordable by connecting members with existing coupon...

Humira Price for Commercial Plans Remained Steep Despite High Rebates

by Victoria Bailey

Despite increasing rebates, the net price of Humira for Medicaid and commercial health plans in 2020 remained high above the launch price, according to a study published in JAMA Network Open. The...

Generic Insulin Drug Pricing, Access Still Pose Problems for Uninsured

by Kelsey Waddill

Following up on a promise that Eli Lilly made in 2019, the offices of Senators Elizabeth Warren (D-MA), Richard Blumenthal (D-CT), and Raphael Warnock (D-GA) conducted a survey on the drug pricing and...

10 Top-Selling Drugs Accounted for 22% of Medicare Part D Spending

by Victoria Bailey

The ten top-selling prescription drugs accounted for more than 20 percent of total gross Medicare Part D spending in 2021, a KFF analysis revealed. Under the Inflation Reduction Act’s Medicare...

Cigna Healthcare Boosts Treatment Access with New Biosimilar Coverage

by Victoria Bailey

Cigna Healthcare has added four Humira biosimilars to its formularies, aiming to increase member access to affordable treatments. Cigna Pharmacy Management, Cigna’s provider of pharmacy...

4 Key Inflators That Are Fueling Medical Cost Trends, Pricing

by Kelsey Waddill

What drivers influence the medical cost trend, and what steps can payers take to address these factors? The medical cost trend is the percentage that experts anticipate treatment costs will grow...

MedPAC Offers Changes to Medicare Advantage Benefits, Payment Policies

by Victoria Bailey

The Medicare Payment Advisory Commission’s (MedPAC) June 2023 report to Congress offered recommendations for addressing disparate Medicare Advantage plan benefits and the future of Medicare...

Inflationary Rebates for Generic Drugs Offset Medicaid Spending

by Victoria Bailey

Inflationary rebates for generic drugs helped offset Medicaid spending from 2017 to 2020, but additional policies are needed to improve generic competition, according to a study published in Health...

AHIP Marketing Campaign Targets Pharma’s Prescription Drug Pricing

by Kelsey Waddill

AHIP has launched a marketing campaign targeting pharmaceutical companies and the role of prescription drug pricing in healthcare spending. “Let’s be clear, Big Pharma continues to...

How Specialty Pharmacies Compare to Provider, Hospital on Drug Pricing

by Kelsey Waddill

AHIP released updated data on drug pricing increases, comparing hospital costs and the prices that physician offices pay compared to specialty pharmacies. The payer organization analyzed price...

Feds Share Details on Inflation Rebates for Medicare Prescription Drugs

by Kelsey Waddill

The Department of Health and Human Services (HHS) and CMS have lowered prices for over two dozen Medicare prescription drugs including biologics for a set timeframe. Starting on April 1, 2023,...

Employer-Sponsored Health Plans Pay More for Drugs than Medicare

by Victoria Bailey

Employer-sponsored health plans paid more than Medicare for most physician-administered drugs with the highest use and the highest spending, according to data published in JAMA Health Forum. In...

HHS Posts Timeline for Medicare 2026 Drug Price Negotiations

by Kelsey Waddill

In accordance with the Inflation Reduction Act, the US Department of Health and Human Services (HHS) announced that Medicare will begin drug price negotiations for prices going into effect in 2026 and...

Community Health Plans Lowered Consumer Healthcare Spending in 2022

by Kelsey Waddill

Alliance of Community Health Plan (ACHP) payers have secured lower healthcare spending for members in 2022 through premium adjustments, efforts related to prescription drug pricing, and more, according...

Out-of-Pocket Healthcare Spending for Generics Rose from 2011-2019

by Kelsey Waddill

While negotiated drug prices dropped, out-of-pocket healthcare spending on generic prescription drugs increased for patients as generics moved from Tier 1 to tiers typically dedicated to brand drugs,...

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