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Competing Priorities: Alzheimer's Drugs and the Delicate Balance that Defines Part D

This article was originally published in RPM Report

Executive Summary

The Alzheimer’s Association waged and won a six-month battle to end prior authorization programs for AD medications in three Medicare plans. The skirmish has big implications for future of Medicare formularies— and the balance of power between Big Pharma and managed care.

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Providers, Payors and Prior Authorization: A Second Front In Pricing Fight

A below-the-radar effort to streamline prior authorization policies could have important implications for easing access to high-priced medicines. A new consensus statement aligns large provider groups with payors on some first principles.

Medco Rethinks Part D: Bailing Out or Mailing it In?

Medco shed over 100,000 Part D members in 2007 and the company couldn't be happier. Medco says it has no interest in serving the poorest Medicare beneficiaries, because they do not use mail order and can't be given viable economic incentives to do so. If other plans start to think like Medco, Part D advocates may have reasons to worry.

The Only Negotiation that Matters?

Economists looking at drug prices under Medicare agree on one thing: without control over formularies HHS won't have the power to drive discounts. One told Congress that instead of giving HHS more power, you should give plans full discretion to set formularies, even in the so-called protected classes. But don't count on that happening any time soon.

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