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

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

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 about...
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OIG proposed rule could help strengthen the Part D market

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

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

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

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

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

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...
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OptumRX: Sharing rebates with patients is “worth it”

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

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

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

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

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

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...
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