Good Day BIO: CMS will apply pharmacy price concessions at point of sale
May 3, 2022
Last week brought positive developments from CMS on reducing patients’ out-of-pocket spending, and BIO’s Dr. Michelle explains why investors should “take a fresh look” at biotech to meet ESG goals. Plus, the new episode of the I am BIO Podcast explores the impact of…
The only newsletter at the intersection of biotech, politics, and policy
May 3, 2022
Last week brought positive developments from CMS on reducing patients’ out-of-pocket spending, and BIO’s Dr. Michelle explains why investors should “take a fresh look” at biotech to meet ESG goals. Plus, the new episode of the I am BIO Podcast explores the impact of Alzheimer’s disease—and how biotechnology is offering hope (and possibly a vaccine). (704 words, 3 minutes, 31 seconds)
There’s no cure for Alzheimer’s disease—which is expected to reach a $1 trillion economic burden in the U.S. as the population ages.
But now, there’s hope—including more investment in R&D, the approval of a new treatment, an experimental gene therapy, and even a potential vaccine that slowed disease progression by 50% in a clinical trial.
In today’s new episode of the I am BIO Podcast, BIO’s Dr. Michelle McMurry-Heath speaks with three guests who are fighting to bend the trajectory of Alzheimer’s:
Maria Carrillo, Chief Science Officer of the Alzheimer’s Association’s Global Research Program
Nolan Townsend, CEO of Lexeo Therapeutics
Mei Mei Hu, Co-Founder, President & CEO of Vaxxinity
The impact: CMS estimates this will save beneficiaries $26.5 billion over 2024-2032.
CMS agreed with BIO’s assessment that applying such concessions at the point of sale does NOT violate Part D’s “Noninterference Clause,” which forbids the government from “interfering in price negotiations in Part D.” The change only specifies where the discount is applied, not the amount, and may have implications for further policy initiatives to reduce beneficiary out-of-pocket spending.
BIO supports this—as well as all such concessions, including negotiated rebates, at the point of sale as a way to lower beneficiary cost sharing. BIO will continue to advocate for this change to further reduce patient prescription out-of-pocket costs.
The final exchange rule (or Notice of Benefits and Payment Parameters) was also a positive step for patients—with a requirement that insurers offer standardized health plan options alongside any non-standardized Qualified Health Plans (QHPs), specifically flat copays for drugs on all tiers of coinsurance.
Additionally, the final NBPP strengthens the enforcement of policies against discrimination in plans. Insurers and pharmacy benefit managers are warned not to design plans that discriminate against people with chronic health conditions by placing all or most drugs to treat a certain condition at the highest tier.
BIO’s long advocated for this change—as well as regulations that prohibit discriminatory benefit design that harm the sickest patients who need the high-value treatments their doctors prescribe. This requirement will limit patient copays and allow for more drugs to be accessed outside of a deductible.
“ESG investing is rapidly becoming a driving engine of the entire financial industry,”writes BIO’s Dr. Michelle McMurry-Heath. “More than $120 billion poured into sustainable investments in 2021, up from $51 billion in 2020, which itself was a 25-fold increase since 1995.”
Enter biotech—which is “emerging at the forefront of the effort to fight climate change and to develop environmentally sound and sustainable products and techniques in areas such as agriculture and waste control,” she says.
What’s Happening on Capitol Hill: The Senate is expected to vote on the America COMPETES Act and the United States Innovation and Competition Act (USICA), which address China’s competitiveness, and Senate committees will begin a number of budget hearings.
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