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States Tackle Drug Pricing
For an assortment of reasons, the federal government hasn’t taken any action on regulating drug prices, so a handful of states have taken matters into their own hands.
For an assortment of reasons, the federal government hasn’t taken any action on regulating drug prices, so a handful of states have taken matters into their own hands. New York, Massachusetts, Maine, Maryland and New Hampshire have established entities with drug pricing powers. Harvard Medical School researchers published an informative overview of the state government efforts in the Milbank Quarterly in August.
As happens when healthcare policy devolves to the states, there’s a lot of variety in how the state-level drug pricing regulation is playing out. The Maine and New Hampshire drug pricing boards advise non-Medicaid, state-financed health plans, but they can’t impose requirements. The Maryland board is also focused on non-Medicaid, state-financed health plans, but it can set upper payment limits on drugs. The Massachusetts board is not a separate board but the Massachusetts Health Policy Commission was set up to find ways to control overall healthcare spending in the state, not just expenditures on drugs. New York has two drug boards, one for the state’s Medicaid program and the other for state-regulated commercial health insurers.
Only the board in New York with authority over the Medicaid program has completed drug-pricing reviews. The Harvard researchers say those reviews have resulted in savings for New York. After the board decided Vertex’s Orkambi (lumacaftor/ivacaftor), a cystic fibrosis drug, was priced too high, the state reached a confidential supplemental rebate agreement with Vertex.
A decision by the board that the state should peg the price for Remicade (infliximab) to the price of an infliximab biosimilar led to another supplemental rebate agreement that benefited the state, according to the Harvard researchers.
Jack Linehan of Epstein Becker Green Discusses Drug Coupons, Accumulators
July 9th 2020In this week's episode of Tuning Into The C-Suite podcast, Senior Editor Peter Wehrwein has a conversation with John "Jack" Linehan, a lawyer for Epstein Becker Green, about coupons and accumulators. Jack is an expert on drug distribution and reimbursement, and few people know as much about coupons and accumulators as he does. Peter and Jack go over some of the basics, who is advantaged and disadvantaged, and then dive into some the details on CMS regulations and how recent proposed changes to Medicaid best price rules would, if finalized, affect coupons and accumulators.
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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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HHS Needs More Rebate Information To Negotiate Medicare Drug Prices, Say USC Experts
February 19th 2024The 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.
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