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If the six protected classes policy is weakened, the Medicare Part D exception and appeals process will not provide sufficient protections for patients facing access challenges

By Tom Wilbur  |    March 29, 2019
One of the most important and successful parts of Medicare Part D is the six protected classes policy which covers patients whose conditions – such as HIV, cancer, and epilepsy, among others – are...   Read More

Fact Check: How the Part B International Pricing Index model threatens patient access

By Nicole Longo  |    March 29, 2019
Since the Department of Health and Human Services (HHS) released the Part B International Pricing Index (IPI) model late last year, there have been a number of inaccurate claims floating around...   Read More

OIG proposed rule could help strengthen the Part D market

By Holly Campbell  |    March 28, 2019
Patients should share in the $166B in rebates and discounts biopharmaceutical companies pay to insurance companies, the government, pharmacy benefit managers and other entities in the supply chain...   Read More

Rebate rule would help ensure seniors with diabetes don’t pay more for their medicine than their insurer

By Holly Campbell  |    March 25, 2019
Misaligned incentives in Medicare Part D are increasing costs for seniors with diabetes. While insurers negotiate larger and larger rebates with biopharmaceutical companies each year, seniors...   Read More

Bipartisan lawmakers urge Administration to rethink proposed changes to six protected classes policy

By Tom Wilbur  |    March 22, 2019
At the end of 2018, the Centers for Medicare & Medicaid Services (CMS) introduced a dangerous proposed rule that would weaken the Medicare Part D six protected classes policy. The six protected...   Read More

New analysis shows 820,000 prescriptions would be in jeopardy if ICER’s value framework is used in Medicaid

By Katie Koziara  |    March 20, 2019
A new analysis from Xcenda found that if Medicaid were to use one-size-fits-all value assessments like the Institute for Clinical and Economic Review’s (ICER) framework as the basis for accessing...   Read More

The PBM story you haven’t heard: Hidden fees quadrupled in two years

By Robert Zirkelbach  |    March 20, 2019
In the ongoing conversation around the role of pharmacy benefit managers (PBMs) in the supply chain, a new report further illuminates incentives that tie PBM revenue to higher list prices for...   Read More

New report: Using march-in authority would jeopardize U.S. innovation

By Tom Wilbur  |    March 19, 2019
In 1980, Congress passed the Small Business Patent Procedures Act, better known as the Bayh-Dole Act, which created a uniform framework for transferring government-funded research into useful...   Read More

OptumRX: Sharing rebates with patients is “worth it”

By Holly Campbell  |    March 18, 2019
PhRMA has long advocated for sharing the $166 billion in rebates and discounts given by biopharmaceutical companies to the government, insurers, and pharmacy benefit managers (PBMs) with patients...   Read More

Changes to the six protected class policy are the wrong prescription for Medicare and HIV patients

By Tom Wilbur  |    March 15, 2019
For over 10 years, one of the cornerstones of the Medicare Part D program has been to ensure the sickest and most vulnerable patients have access to the clinically critical medicines they rely on....   Read More

Special 301 submission calls for a level playing field for American innovators

By Megan Van Etten  |    March 13, 2019
The Office of the U.S. Trade Representative (USTR)’s 2019 Special 301 Report – scheduled to be released this spring – brings critical attention to overseas intellectual property (IP) and market...   Read More

New analysis finds Average Sales Price system has led to significant cost savings for Medicare and seniors

By Nicole Longo  |    March 7, 2019
When Congress created the Medicare Part D program as part of the Medicare Modernization Act of 2003 (MMA), it also implemented changes to Part B to make it market based with the creation of the...   Read More

New “Prescription for Medicare” campaign focuses on impacts of wrong and right solutions for Medicare

By Juliet Johnson  |    March 6, 2019
Today, we are launching the “Prescription for Medicare” campaign which focuses on ensuring that changes made to Medicare are the right prescription for seniors. There’s a lot of talk in Washington...   Read More

Repealing Part D noninterference clause threatens access and choice for America’s seniors

By Tom Wilbur  |    March 5, 2019
For more than a decade, Medicare Part D has successfully provided seniors access to comprehensive prescription drug coverage with low and stable premiums, while negotiation within its unique...   Read More

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