CER Daily Newsfeed

Tracing The Arc Of Medication Utilization Management Over Time

(6/3, Kimberly Westrich, Lisabeth Buelt, James Motyka, Jonathan D. Campbell, Health Affairs Forefront) comments “...Moving forward, policy makers and other health care stakeholders must critically evaluate the use of UM policies for prescription drugs. To advance more value-based, patient-centered care, we must also address the interplay among widespread UM, restrictive formulary design, and rising patient out-of-pocket costs. Efforts to reform UM policies must prioritize clinical value, improve transparency, ensure alignment with evidence-based guidelines, and remove inappropriate restrictions on medication access.” Full

Contributor: Beyond the Sloganeering—A Data-Driven Analysis of Recent 340B Growth

(6/3, William A. Sarraille, JD, Shanyue Zeng, MA, John Michael O'Brien, PharmD, MPH, Rory Martin, PhD, The American Journal of Managed Care) comments “...The explosive growth in the 340B program—and the growth of subsidies derived from the ‘spread’ between lower acquisition prices and reimbursement value—is a source of significant concern to payers, which must pay that spread. As the policy debate about the 340B program rages, 340B advocates have claimed that manufacturer prices increases are to blame for the program’s growth, including its alarming 24% increase in just a single year in 2023. Our analyses do not support that assertion. Whether we examine drugs from 2018 to 2024, the much smaller subset of drugs that had list price increases that exceeded the rate of inflation, or the top 10 drugs identified by HRSA in 2023, the answer was the same—the 340B program’s growth is predominately a function of utilization increases, not price.” Full

340B May Move from HRSA to CMS: What You Need to Know

(6/2, Bridget Early, Modern Healthcare) reports “...CMS would receive $12 million to run 340B in fiscal 2026 under the budget request, the same amount allotted to HRSA this year. HRSA itself would be absorbed into the new Administration for a Healthy America as part of an ongoing effort by Secretary Robert F. Kennedy Jr. to restructure the department...Responsibilities would include ‘providing technical assistance to grantees and covered entities, performing eligibility checks and annual recertifications, conducting audits, and maintaining the critical Office of Pharmacy Affairs Information System that underpins 340B operations,’ HHS wrote in a report on its budget request plan to Congress on Friday.” Subscription Required

The Medicare Drug Price Negotiation Program, Year Two: Effects On Access And Innovation

(6/3, Laura Tollen, Health Affairs Forefront) comments “...[S]takeholders were waiting with bated breath for CMS to release its statutorily required justification of the first 10 drugs’ prices, signaling the agency’s priorities. However, when these justifications were published in December of 2024, they were heavily redacted and disappointingly general. Nevertheless, some experts have inferred from them that comparative effectiveness data and RWE likely played an important role. In cases where two drugs in the same class were under negotiation—and there were no available head-to-head clinical trials—the two drugs nevertheless received quite different prices, presumably because comparative effectiveness data or RWE supported such a difference.” Full

Trump’s Executive Order To Lower Drug Prices Still Lacks Crucial Details

(6/3, Joshua P. Cohen, Forbes.com) comments “...There have been dozens of models proposed since the founding of CMMI. Some of the proposed models, including ones on international price referencing, never got tested. The majority of models that did get implemented failed to yield cost savings. And thus far, only two have been made a permanent part of a public program: a diabetes and accountable care organization demonstration project became a permanent fixture in Medicare. However, most models have been canceled, including recently a value-based insurance design initiative in Medicare Advantage which the Biden administration nixed in Jan.” Full

US ‘Most Favored Nations’ Drug Pricing Policy Will Jeopardize Innovation In Europe

(6/3, Francesca Bruce, Pink Sheet) reports “...The US MFN executive order is the latest in a series of concerning US developments that are contributing to uncertainty for the European pharmaceutical industry, according to France Biotech’s vice president, Alexandre Regniault.” Subscription Required

UK: AstraZeneca’s Forxiga Recommended by NICE for Wider Chronic Kidney Disease Use

(6/3, Emily Kimber, PMLiVE) reports “AstraZeneca (AZ) has announced that a wider range of chronic kidney disease (CKD) patients across England and Wales will be able to access Forxiga (dapagliflozin), following updated final draft guidance from the National Institute for Health and Care Excellence (NICE).” Full