Rebates as the answer to provider worry about IRA price negotiation and loss of buy-and-bill revenue | Asembia AXS26 Summit

IRA drug price negotiations and a looming reimbursement challenge for physicians are very much on the minds of policymakers and industry stakeholders, according to Lindsay Greenleaf, J.D., MBA.

Greenleaf, head of market access policy strategy at ADVI Health and a member of the Managed Healthcare Executive (MHE) editorial advisory board, spoke at a session on drug pricing today at the Asembia specialty pharmacy summit in Las Vegas.

In an interview with MHE, Greenleaf said the panel addressed how the IRA negotiation process has evolved from the Biden administration to the current Trump-led effort, along with lingering policy questions still to be resolved. She identified one issue commanding particular attention: "Part B drug effectuation of the maximum fair price," or the maximum fair price (MFP), which is the relatively new acronym for prices CMS has negotiated under the IRA.

Physicians who purchase and administer drugs under the buy-and-bill model are concerned that MFP prices will sharply reduce their buy-and-bill revenue. Although the impact won't be felt until January 2028, Greenleaf cautioned that the timeline is shorter than it appears. "CMS is actively working on this, and we're going to get some notable regulations out of them very soon," she said.

Provider groups, notably community oncologists, are pushing for changes, Greenleaf said. They want to be taken out of the middle “of this whole thing” and have manufacturers pay a rebate to the federal government rather than have drug prices discounted. It would take legislation to make that change, she noted. The Trump administration has proposed to effectuate most-favored-nation pricing for physician-administered drugs using rebates, according to Greenleaf.

“They're [the provider groups] saying, ‘Look, this is something that you all thought was a smart enough thing to do over here, let's apply it over here for IRA negotiated prices.’ So that's the cleanest approach, where manufacturers would pay the government a rebate.” The rebate would get the price paid by the government down to the MFP level, she said

“Meanwhile, providers, from their perspective, they would be buying and billing. It'd be business as usual,” Greenleaf said.

Getting legislation through Congress is never easy, she remarked. “We would love for Congress to act on that and move on that very soon. But as you know, Congress does not tend to solve problems early.”