Medicare And Medicaid To Pilot 3 Experiments Aimed At Lowering Drug Costs
The Biden administration Thursday announced a roadmap to test three drug pricing models. The programs would offer some generic drugs to Medicare beneficiaries for $2 a month, experiment with new ways for Medicaid to pay for expensive cell and gene therapies, and explore ways to pay for drugs approved under accelerated FDA review.
Reuters:
U.S. Proposes Medicare, Medicaid Programs To Cut Drug Costs, Including $2 Generics
The U.S. health department proposed on Tuesday three new pilot projects aimed at lowering prescription drug prices for people enrolled in government health insurance plans, including offering some essential generic drugs for $2 a month. The Centers for Medicare and Medicaid (CMS) said it would test the models in the Medicare health program for people age 65 or over and the disabled and the Medicaid program for the poor. (Aboulenein, 2/15)
Axios:
The Administration's Next Crack At Lower Drug Prices
The three programs focus on different classes of treatments and coverage. One would encourage Medicare prescription drug plans to offer a standardized set of about 150 generic drugs to patients for a maximum copayment of $2 per month. The list would target drugs for chronic conditions like hypertension.
Another would give state Medicaid agencies the option to coordinate with manufacturers and other states to test new ways to pay for gene and cell therapies based on health outcomes. (Goldman and Owens, 2/15)
Stat:
Biden Admin Pitches 3 Big New Drug Pricing Reform Experiments
The new proposals are the result of an executive order President Biden signed last year directing the administration to develop demonstrations that would complement Democrats’ new drug pricing law. The Centers for Medicare and Medicaid Services uses demonstrations to pilot test policy ideas, and if those policies work out, the agency can expand them into programs without the approval of Congress. The law Democrats passed last summer directs Medicare to negotiate drug prices, makes drug companies pay back Medicare when price hikes outstrip inflation, and caps seniors’ annual spending for retail drugs — but it will take years to fully implement. (Cohrs and Wilkerson, 2/14)
Fierce Healthcare:
CMMI Releases Three New Models Aimed At Lower Generic, Novel Drug Costs
The three models initially chosen will also test: A model to address the skyward cost of gene and cell therapies for diseases like sickle cell and cancer that can come with a price tag of up to $1 million. The goal is for state Medicaid agencies to assign CMS to “coordinate and administer multi-state, outcomes-based agreements with manufacturers for certain cell and gene therapies,” CMS said. (King, 2/14)
In related news about the cost of insulin —
KHN:
Armed With Hashtags, These Activists Made Insulin Prices A Presidential Talking Point
Hannah Crabtree got active on Twitter in 2016 to find more people like herself: those with Type 1 diabetes who’d hacked their insulin pumps to automatically adjust the amount of insulin delivered. Soon, though, Crabtree found a more critical diabetes-related conversation happening on Twitter: rising insulin prices. (Sable-Smith, 2/15)
Doctors are pushing for an overhaul of Medicare payments —
Axios:
Doctors Prod Congress To Do More On Medicare Pay
Top doctors groups are pressing Congress to overhaul the way Medicare pays physicians just as lawmakers are getting pulled into the politically charged debate over possible cuts to entitlement programs. The new appeals serve notice that there's political risk if provider cuts become part of conservative-led efforts to balance the federal budget or a deal on raising the debt limit. (Dreher, 2/15)
Stat:
Doctors' Top Lobbyist On Medicare Money, Burnout, & Private Equity
Doctors have so far managed to sidestep the thorny political debates about cost and value that have put pharmaceutical, insurance, and hospital executives in the congressional crosshairs. Instead, they’re in D.C. this week to ask for help. (Owermohle, 2/15)
