Terance Gonsalves’ Post

Part D Formularies Get More Restrictive, but MA-PDs Beat PDPs on Access: Medicare Part D formularies are becoming more restrictive over time, asserts new research published in the March issue of Health Affairs. Studying Medicare administrative data that included Part D claims and plan formulary characteristics, researcher... Read More #marketaccess #lifesciences #pbm

As part of the IRA, CMS has just released the projected savings for those with Medicare Part D coverage. This initiative offers visibility into the impacted drugs and costs for plan members. Although the newly negotiated prices will not take effect until 2026, the information provided is crucial for stakeholders to prepare for the upcoming changes. Most plans have insight into their own utilization and spend, but how do they compare in the market against their competitors? We have the claims data to provide an in depth analysis, down to the MSA. #Medicare #Healthcare #CMS #IRA #MedicarePartD #Savings

Breaking News: The FTC is taking a stand against skyrocketing insulin prices by suing three major U.S. health companies, accusing them of prioritizing profits over patients' well-being. With millions of Americans affected, this lawsuit could bring much-needed change to the healthcare system. Read more: https://lnkd.in/dke3RBys #HealthCareReform #InsulinPrices #DrugPricingCrisis #FTC #PharmacyBenefitManagers #PBMs #AffordableHealthcare #PatientAdvocacy #BigPharma #InsulinForAll #HealthcareCosts #PharmaLawsuit #PrescriptionPrices #DiabetesCare #JusticeForPatients #HealthPolicy #MedicareReform #DrugPricingReform #BreakingNews

This Health Affairs piece – from a group of authors that includes former CMS head Mark McClellan and SSR Health pricing expert Richard Evans – is a reminder that the final price set by CMS is only a part of the story. Perhaps the most important point in the piece is a reminder that payers will have a financial incentive to push patients away from price-controlled medicines to more profitable products where the rebates – and profits – are greater. That’s an area where the authors point out that CMS “has not yet provided guidance on how it will [assess formulary placement], nor on the consequences for plans’ undesirable behavior.” It’s a reminder that implementation of the IRA will require vigilance to make sure that PBMs don’t try to turn the law into another avenue for steering savings away from patients. https://lnkd.in/eJtRAcWk

Recently, Centers for Medicare & Medicaid Services posted draft guidance for the Medicare Drug Price Negotiation Program. Learn what the key takeaways of that draft guidance are and what they mean for plans in this updated blog from Michael Kolodij. https://lnkd.in/gurn6Y9f

🤷♂️ There’s a lot of uncertainty in the patient community about the impact of the Inflation Reduction Act (IRA) and the ongoing Medicare drug pricing negotiations. Many patients are unsure or unaware of how these changes might affect them. While the government is working to reduce drug prices—with the first round of negotiations seeing reductions between 38% and 79%—𝐭𝐡𝐞 𝐥𝐨𝐧𝐠-𝐭𝐞𝐫𝐦 𝐢𝐦𝐩𝐚𝐜𝐭 𝐫𝐞𝐦𝐚𝐢𝐧𝐬 𝐮𝐧𝐜𝐥𝐞𝐚𝐫, 𝐥𝐞𝐚𝐯𝐢𝐧𝐠 𝐦𝐚𝐧𝐲 𝐟𝐞𝐞𝐥𝐢𝐧𝐠 𝐮𝐧𝐬𝐞𝐭𝐭𝐥𝐞𝐝 𝐚𝐛𝐨𝐮𝐭 𝐰𝐡𝐚𝐭’𝐬 𝐭𝐨 𝐜𝐨𝐦𝐞. 💰 It’s critical that patients are educated and aware of how these negotiations might impact their care and out-of-pocket costs. We need to stay informed and help ensure our patients understand what’s coming so they can navigate these changes the best they can. #PatientAdvocacy #Medicare #HealthcareChanges #IRA #PatientEducation #HealthLiteracy #BridgeTheGap #DrugPricing

This article does make some valid points about 340B, but there are many things it fails to consider. ❌ Myth: Patients don't benefit from 340B discounts. ✅ Fact: While there's room for improvement in accessibility, countless patients rely on the reduced prices facilitated by 340B to access essential medications. These discounts DO make a tangible difference in affordability for many. ❌ Myth: Contract pharmacies aren't integral to the program. ✅ Fact: The evolution of contract pharmacies has expanded access to 340B medications, particularly in underserved areas. This growth represents progress in reaching those who need assistance the most to ensure no one is left behind. ❌ Myth: Transparency is lacking in 340B transactions. ✅ Fact: Efforts to enhance transparency are ongoing, but let's not overlook the core mission of 340B: to support healthcare providers serving vulnerable populations. The 340B program has made strides in expanding access to vital medications and healthcare services. There's always room for improvement, but let's not lose sight of the countless lives positively impacted by this essential initiative. #340B #Healthcare #Medications

The 10/2 Healthcare Labyrinth Newsfeed is live. Click below to read. Major stories: -- Trump back tracks on drug price reform -- VP debate tackles healthcare -- Senators want FTC to investigate PBM co-manufacturing -- Humana hit with low Star ratings for 2025 -- Maternal health gaps in Medicaid -- More on CVS woes -- 2027 drug price negotiations guidance #healthcare #healthcarereform #healthinsurance The Healthcare Labyrinth Marc S. Ryan 🇺🇦 https://lnkd.in/excks5UU

The 10/2 Healthcare Labyrinth Newsfeed is live. Click below to read. Major stories: -- Trump back tracks on drug price reform -- VP debate tackles healthcare -- Senators want FTC to investigate PBM co-manufacturing -- Humana hit with low Star ratings for 2025 -- Maternal health gaps in Medicaid -- More on CVS woes -- 2027 drug price negotiations guidance #healthcare #healthcarereform #healthinsurance The Healthcare Labyrinth Marc S. Ryan 🇺🇦 https://lnkd.in/edp3q4aE

Institute for Clinical and Economic Review (ICER)'s Sarah Emond has asked the questions that anyone who understands #HTA first principles should ask: what DO we know and what DON'T we know about how Centers for Medicare & Medicaid Services arrived at negotiated prices for the first round of 10 drugs? There's a hint that value assessment may have played some role, but it all depends on how negotiation factors were weighted, what the therapeutic alternatives were, and many other considerations: https://lnkd.in/eka-Rhcf