CER Daily Newsfeed

The Future of Drug Pricing: Most Favored Nation, PBMs, and Patient Access

(7/11, Laura Joszt, MA, The American Journal of Managed Care) reports “...[NPC president and CEO John O’Brien, PharmD, MPH] speculated that this order was more about trade and the middlemen, or PBMs, for the president. The executive order called for HHS to create a direct-to-consumer (DTC) sales model that would bypass PBMs, which could disrupt the traditional supply chain. Just understanding the actual cost of a drug can be complicated when taking into account rebates and other aspects of US health insurance. ‘We no longer see drugs compete on what's the best one at the lowest cost,’ O’Brien said. ‘It's now a high-list, high-rebate preference for the middlemen, and I think that's why patient out-of-pocket costs are what really matter, and that's what's driving pollsters telling politicians that drug pricing is something that they should be focused [on].’” Full

Value Viewpoint: July 12, 2025

(7/12, Kimberly Westrich, LinkedIn) comments “Two new Value in Health pre-proof articles this week use Delphi groups to elicit key value factors for inclusion in HTA and health systems more broadly. 1. Achieving Patient-Centered V/HTA: Recommendations from a Multi-Stakeholder eDelphi Panel seeks to identify opportunities and create recommendations for fostering the development of patient-centered HTA...2. Building blocks of value creation within value-based health systems: a Delphi study similarly seeks to create a consensus-driven framework on the key factors influencing value creation in health technologies as well as system-level barriers that may exist.” Full

Real-World Data Supports Amtagvi’s Benefit in Advanced Melanoma

(7/14, Spencer Feldman, Cure) reports “...At four authorized treatment centers, 41 patients were evaluable for response, with physicians reporting an overall response rate (ORR) of 48.8% (20 of 41). Patients who received Amtagvi in the third line or earlier (two or fewer prior therapies) had a higher ORR of 60.9% (14 of 23), while those treated after three or more previous therapies had an ORR of 33.3% (6 of 18).” Full

The Case For Integrated ACOs For Dual-Eligible Beneficiaries

(7/14, José F. Figueroa, Eric T. Roberts, Jessica Phelan, Kenton J. Johnston, Health Affairs Forefront) comments “...CMS should seize this moment to reconsider an integrated ACO model for dual eligibles. Doing so would build on a decade of progress in Medicare ACOs, push beyond the limitations of current managed care integrated care models, and better align provider incentives to deliver truly coordinated, high-quality, person-centered care. For a population that consistently falls through the cracks of our health care system, integrated Medicaid accountability through ACOs could be a long-overdue step toward realizing the promise of better care.” Full