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Simmering tensions in the pharmacy benefit management (PBM) industry have turned into fault lines. The PBMs challenging the "big three" have formed a trade association. Purchaser coalitions want change. The head of the industry's trade group says inherent marketplace friction has spilled over into political friction.

In this second part of a video series, AMCP CEO Susan Cantrell addressed the impact of high prescription drug prices on underserved communities, highlighting disparities in access caused by the pandemic's effects on minority populations. On the industry blame debate, she urged collaborative solutions, mentioning AMCP's engagement with diverse stakeholders to find comprehensive, patient-centric solutions and advocate for policy changes like the MVP Act to address rising costs and access challenges.

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The Health and Human Services department could wind up overpaying (or possibly underpaying) for the drugs for which it is negotiating a “maximum fair price” for Medicare under the Inflation Reduction Act, argue experts at the USC Schaeffer Center for Health Policy and Economics. A fuller picture of rebates and net prices could help that from happening, they say.

ICER adds a more formal process to evaluate the diversity of clinical trials and an assessment of a product’s impact on patient and caregiver productivity. ICER also plans to evaluate how newer methods — which would consider the change of a drug’s price over time and disease severity — can be applied to its value assessment.

An analysis by 3 Axis Advisors has found that there is a large variability in pharmacy reimbursement of prescription drugs depending on PBM contracts with insurers. This creates a system with huge inconsistences on the prices of both generics and branded products.

Recent years have brought a host of new orphan medications for rare disorders, and more are coming. But the U.S. hasn’t yet settled on a way to handle their often astronomical prices — and neither has any other country.

Two studies published this week documented the billions that Medicare and Medicaid spend on drugs that have been granted accelerated approval by the FDA based on surrogate end points. A study reported today in JAMA Health Forum found that only 6 of the 22 confirmatory trials used clinical outcomes.

Kirsten Axelsen, Richard Frank and Rachel Sachs agreed that the rapid development of the COVID-19 vaccines was a government-business success story. There was less to celebrate as the Kaiser Family Foundation panelists also unpacked the legal issues and economic consequences of drug rebates, international reference pricing, high deductible health coverage and compulsory licensing.