Under test payment model, Medicare would pay no more than most-favored-nation price for Part B and Part D drugs, but how and when the model program would be implemented remains unclear. BIO may pursue legal action as questions on how plan would be implemented and if the administration will provide notice and comment period for stakeholder input remain.
President Trump issued an executive order to limit the amount Medicare pays for Part B and Part D prescription drugs and biologics to the “most-favored-nation” price but it is uncertain what an implementing rule would consist of and when the model payment plans would be implemented.
What seems clear from the administration’s many drug pricing announcements is that the president hopes to make antagonism of biopharma...
The Centers for Medicare and Medicaid Services is considering imposing price inflation rebates on Part B drugs furnished to enrollees in Medicare Advantage plans in addition to those covered by fee-for-service Medicare.
Doctors are increasingly falling victim to financial scams due to their high incomes, busy schedules, and trust in professional networks. Recognizing the tactics scammers use and the reasons behind physicians’ susceptibility is essential for protecting medical professionals.
US lawmakers will undoubtedly continue to work on pharmacy benefit manager reform legislation in 2025, given its bipartisan support. But policies impacting rebates that could lead to higher premiums in Part D may be a tough sell in the midst of the benefit redesign.
Medicare coverage with evidence development final guidance includes few substantive changes from the proposed version despite biopharma stakeholder concerns.
Congressional Budget Office responses to questions from US lawmakers on pharmacy benefit managers could add to the momentum for PBM reforms to go further than the current leading proposals.
Pink Sheet reporter and editors discuss the take-aways from the landmark first Medicare negotiated drug prices and what additional information remains outstanding.
But the amount of savings realized when the Medicare negotiated prices go into effect in 2026 remains the subject of debate.
