Radar on Drug Benefits

With Congress continuing to debate a measure that would allow the Medicare program to negotiate drug prices with manufacturers, a new Kaiser Family Foundation (KFF) poll has found that “large majorities” of U.S. adults support such a move, “and this support holds steady even after the public is provided the arguments being presented by parties on both sides of the legislative debate.”

But the Pharmaceutical Research and Manufacturers of America (PhRMA) is striking back, with a spokesperson sending an email to reporters on Oct. 12 that accuses KFF of “joining the partisan fray and political advocacy groups who are trying desperately to build congressional support for government price-setting.”

CMS, in its recent release of 2022 star ratings for private Medicare plans, reported that the percentage of members in plans rated 4 stars and above rose for both Medicare Advantage Prescription Drug (MA-PD) plans and stand-alone Prescription Drug Plans (PDPs).

MA-PD plans’ performance is getting the most buzz — perhaps because an eye-popping 90% of current enrollees are in plans that will be rated 4 stars or higher in 2022, up from 77% of MA-PD enrollees in 2021. Still, PDPs’ year-over-year percentage increase of members in highly rated plans is also notable.

Merck & Co. has made waves by claiming one of its antiviral drugs, molnupiravir, could reduce hospitalizations for COVID-19 by roughly half — as has the company’s announced plans to seek emergency use authorization (EUA) from the FDA for the drug.

Experts are optimistic that the drug could be the first of several new therapeutics and prophylactics for COVID-19 — but caution that molnupiravir may not be right for every patient, requires scaled-up production and could be more costly in the commercial market than many expect.

The Part D Enhanced Medication Therapy Management Model launched in 2017 with the intention of incentivizing prescription drug plans (PDPs) to investigate new strategies to optimize medication therapy management (MTM) programs and ultimately reduce Medicare costs. This five-year program, launched across five different Part D regions, is about to come to an end, raising questions such as: What are some of the lessons learned? How could expanding the scope of traditional MTM programs improve outcomes?

Health care solutions company Tabula Rasa HealthCare partnered with Blue Cross and Blue Shield Northern Plains Alliance, a model participant, to improve its MTM program. Now, the company has published a series of papers in the American Journal of Managed Care (AJMC) demonstrating how identifying at-risk patients and optimizing medication regimens at the pharmacist level can impact health care costs and outcomes for Medicare beneficiaries.

Although House Democratic leaders recently suffered a setback when a trio of moderates in a key committee voted against a sweeping set of drug pricing reforms, health care policy experts tell AIS Health that the pharmaceutical industry has every reason to be worried about the prospect of government price controls becoming law.

As one Capitol Hill insider put it: “The drug lobby has never been as worked up and worried before as they are right now, and the reason is because there is an extreme likelihood that something is going to pass.”