Member: Radar on Specialty Pharmacy

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HHS’s Proposed Rebate Rule Could Transform Pharma Industry

February 1, 2019

HHS finally released a long-awaited proposed rule that, if implemented, stands to have a wide-reaching impact on the pharmaceutical industry. The proposal targets drug rebates provided by pharmaceutical manufacturers to plan sponsors under Medicare Part D and Medicaid MCOs and to PBMs contracting with them. The approach would pose an array of logistical challenges to multiple stakeholders but also would shed some light on a practice that has been in the crosshairs recently.

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PhRMA Is Allegedly Considering Limiting Members’ Price Hikes

February 1, 2019

As the Trump administration continues to take aim at drug prices, one industry group is reportedly mulling over a proposal that would limit its members’ price increases for those treatments purchased by Medicare. The approach, according to the publication BioCentury, is an attempt to get HHS to back off implementing its International Pricing Index (IPI) model. If implemented, the proposal could be a mixed bag for various stakeholders, experts tell AIS Health.

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ICER Will Examine Drugs With Unsupported Price Increases

February 1, 2019

As the spotlight on manufacturers’ raising the prices of therapies already on the market shows no sign of dimming, one industry group recently unveiled its intentions to dig a little deeper into the topic. The Institute for Clinical and Economic Review (ICER) says it will create a series of so-called Unsupported Price Increase (UPI) reports that will examine whether price increases are justified. At least one industry expert contends that while there may certainly be some benefits to the data ICER will collect, there are multiple challenges in its approach, and the information may be of limited use to commercial payers. With many specialty therapies experiencing large price increases, manufacturers will need to be able to convey their products’ value.

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Biosimilars Market Is Picking Up Steam, Could See Boom Soon

February 1, 2019

Biosimilars are one way that payers had hoped to bring down spending on pharmaceuticals, but as of yet, these products have had little impact in the United States. As of mid-January, the FDA had approved 17 biosimilars, but only a handful actually are available in the U.S. However, the products may pick up more traction in 2019, with some significant ones potentially coming to market.

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Novel Drugs, High Prices, Ways To Manage Them Remain Hot

February 1, 2019

With the FDA approving multiple novel new therapies over the past couple of years, we should expect to see more of the same moving forward. But that innovation comes at a price, and even with all the pressure to keep drug prices down, the pharmaceutical industry likely will continue to offer products at higher price points than ever before. In this context, drug pricing and innovation will continue to dominate the specialty drug headlines.

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