Negotiated Drug Prices - Who Wins?

[somarco]

“After all of this, what does success look like?” asked Peter Neumann, a professor of medicine at Tufts University.

It turns out, the answer to that question is not straightforward, but conceptually there are ways to get at it.

To save money, Medicare prices need to be lower than the prices that health plans already negotiate, minus the automatic discounts that drugmakers pay Medicare, she said. That’s because drugs chosen for negotiation are exempt from those automatic discounts of 10% to 20% in Part D.

Health plans already negotiate rebates that lower the price of Eliquis to $3,708 and Xarelto to $3,135, according to an analysis from Hernandez, so the Medicare negotiated price would need to be at least 10% to 20% lower than that to decrease Medicare spending on those drugs.

“But the drug pricing provisions in the Inflation Reduction Act ended up being much more modest than advocates had hoped.”

How to tell if Biden drove a hard bargain on drug prices

Drug prices in other countries and the value that treatments deliver for patients are among the ways to figure out if Medicare struck good deals with pharma compaies.

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[just-a-client]

I wondered about that but CMS is reporting $6B in savings to Medicare across the 10 drugs. One can reasonably assume it's a mix of savings and at least conceivably no savings at all for some, so it's an average. And I think I also read $1.5B savings in cost sharing. That will depend on the plan. With the MAPD plans that charge only copays, esp if no Rx deductible, cost sharing won't change. All PDP tier 4 are coinsurance, and probably more than half Tier 3 now, more and more each year, so that would mean good savings. And then the $2000 moop kicks in quickly. Users of these 10 drugs will be very happy with the IRA changes.

The negotiation takes a lot of confidential information into account - I read it but then my mind exploded. In general it looks like they met or exceeded the best prices currently available. Plus they refer to net prices which I think would mean the true price after rebates and concessions are also folded in.

(Offering these thoughts as a non-professional retiree.)

 

[somarco]

The $2k max OOP may be delayed . . . now that Congress has figured out their tinkering with Part D will end up COSTING most seniors more, not save money as advertised.

About 5% of the senior population will save money, the rest are taking it in the shorts.

DC is trying to figure out how to postpone the promised 2025 changes for a year in order to help Camela in her quest for her first elected office position.

And FWIW, when DC talks about saving $$ they mean saving THEM money, not us. Any savings on that side of the ledger means more $$ to throw at "free stuff"vote buying programs.

DC is not here to save us in spite of their rhetoric.

 

[MedicareWAA]

The $2k max OOP may be delayed

I’m not sure where you get your news but this isn’t happening. Partly because the law says otherwise. There’s no way the law is changing this fall.

You cannot executive order your way out of that cap. You can demo your way to a lower cost to enrollees and that’s what we see happening right now.

 

[somarco]

The operative word is "MAY" . . .

DC has the ability to use administrative changes without altering legislation by manipulating and amending the regulations, including delayed implementation.

Laws and regulations are both legal instruments that establish requirements or prohibitions, but they differ in how they are created and implemented:

Laws
Also called statutes or codes, laws are written and passed by the legislative branch of government, such as Congress or state legislators. Laws define conduct for aspects of daily life that are under the government's authority. For example, the Securities and Exchange Act prohibits using insider information to make trades.

Regulations
Also called rules, regulations are written by agencies, such as the Environmental Protection Agency, to implement laws passed by the legislative branch. Regulations clarify how an agency interprets a law and how it will be implemented. For example, the SEC can have its own rules on how it will investigate charges of insider trading. Regulations are often adopted under authority granted by statutes and have the force of law. They often include penalties for violations and are codified and published so that people are aware of what is and isn't legal

Laws establish requirements or prohibitions. Regulations are published by executive branch agencies to clarify their interpretation of a law and how a law will be implemented.

Regulations are not voted on, but they are created by executive branch agencies to clarify how a law will be implemented and how the agency interprets it.

Obamacare legislation had 2300 pages which were never read before the final vote by Congress. The regs (which are still being amended) number more than 11,000 pages.

Civics 101 . . .

 

[MedicareWAA]

The operative word is "MAY" . . .

DC has the ability to use administrative changes without altering legislation by manipulating and amending the regulations, including delayed implementation.

Laws and regulations are both legal instruments that establish requirements or prohibitions, but they differ in how they are created and implemented:

Laws
Also called statutes or codes, laws are written and passed by the legislative branch of government, such as Congress or state legislators. Laws define conduct for aspects of daily life that are under the government's authority. For example, the Securities and Exchange Act prohibits using insider information to make trades.

Regulations
Also called rules, regulations are written by agencies, such as the Environmental Protection Agency, to implement laws passed by the legislative branch. Regulations clarify how an agency interprets a law and how it will be implemented. For example, the SEC can have its own rules on how it will investigate charges of insider trading. Regulations are often adopted under authority granted by statutes and have the force of law. They often include penalties for violations and are codified and published so that people are aware of what is and isn't legal

Laws establish requirements or prohibitions. Regulations are published by executive branch agencies to clarify their interpretation of a law and how a law will be implemented.

Regulations are not voted on, but they are created by executive branch agencies to clarify how a law will be implemented and how the agency interprets it.

Obamacare legislation had 2300 pages which were never read before the final vote by Congress. The regs (which are still being amended) number more than 11,000 pages.

Civics 101 . . .

Thanks for the civics lesson. They're not going to delay the out of pocket max.

 

[somarco]

@MedicareWAA glad to clear that up. You seemed confused about how the bureaucrats can manipulate laws to match the whims of the party in power.

Since you have decreed that the OOP won't be delayed until 2025, what would you suggest they do to hide the premium increases, copay increases, tier shifts, fewer PDP carriers, smaller formulary, etc from the voters in the upcoming election?

 

[axeman462]

@MedicareWAA glad to clear that up. You seemed confused about how the bureaucrats can manipulate laws to match the whims of the party in power.

Since you have decreed that the OOP won't be delayed until 2025, what would you suggest they do to hide the premium increases, copay increases, tier shifts, fewer PDP carriers, smaller formulary, etc from the voters in the upcoming election?

Distract the voters with race riots and political rhetoric about orange man bad?

 

[Chazm]

@MedicareWAA glad to clear that up. You seemed confused about how the bureaucrats can manipulate laws to match the whims of the party in power.

Since you have decreed that the OOP won't be delayed until 2025, what would you suggest they do to hide the premium increases, copay increases, tier shifts, fewer PDP carriers, smaller formulary, etc from the voters in the upcoming election?

I can’t imagine any way they delay the $2k moop. That would be a huge blow to Harris. Us, as agents, know that’s it better. But the public won’t see it that way.

 

[axeman462]

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