Medicare Part D Redesign: New Discounts Will Not Apply To Drugs With ‘Negotiated’ Prices
However, Part D drugs subject to government price setting under the Inflation Reduction Act will still face pharmacy benefit manager demands for additional rebates in return for preferential formulary status.
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Guidance on how to implement a new policy to permit Part D beneficiaries to pay high copays in monthly installments (rather than all at once at the pharmacy counter) shows that there is no such thing as a straight-forward change in the drug benefit program.
Increased application of utilization management controls expected as plans face higher costs under the redesign. However, the formulary advantages available to drugs in the protected classes may lead developers to sharpen their focus on those categories.
The US Medicare Payment Advisory Commission is continuing its work on proposals to overhaul federal payment for physician administered drugs. That is an ominous message for the biopharma industry as it reels from passage of dramatic pricing legislation earlier this year.