Government Payers

RSV Vaccines: ACIP Recommendations For Adults Younger Than Age 60 Await More Data

RSV Vaccines: ACIP Recommendations For Adults Younger Than Age 60 Await More Data

 
• By 

GSK’s Arexvy and Pfizer’s Abrysvo are FDA-approved for individuals younger than 60 years old, but CDC’s Advisory Committee on Immunization Practices wants more data on Guillain-Barré syndrome cases in older adults and efficacy in severely immune-compromised persons before making a recommendation.

‘The Right Call:’ Australia’s PBAC Addresses ‘Unprecedented’ Backlog With Extra Meeting

‘The Right Call:’ Australia’s PBAC Addresses ‘Unprecedented’ Backlog With Extra Meeting

 

The government’s decision for the Pharmaceutical Benefits Advisory Committee to hold an extra meeting in 2025 has been welcomed by Medicines Australia, which says that Australians already wait on average 466 days from the time a medicine is approved to when it is subsidized.

US Elections: Republican Sweep Would Ease Path For Biopharma Policy Priorities

US Elections: Republican Sweep Would Ease Path For Biopharma Policy Priorities

 
• By 

While election results are not complete, prospects improve under new regime for 340B program reforms, PBM legislation, and Inflation Reduction Act drug pricing revisions. But immediate priorities for Congress and the new president will be elsewhere.

Medicare Definitions Of ‘Bona Fide Marketing,’ And ‘Single-Source Drug’ May Be Inconsistent With Law, Appeals Court Says

Medicare Definitions Of ‘Bona Fide Marketing,’ And ‘Single-Source Drug’ May Be Inconsistent With Law, Appeals Court Says

 

An appeals court panel seemed skeptical of whether AstraZeneca has standing in its Administrative Procedure Act challenges against the IRA’s drug price negotiation program, but suggested a company with standing might be successful in their court.


IRA Litigation: Pharma’s Exit Options Irk Third Circuit Judges

IRA Litigation: Pharma’s Exit Options Irk Third Circuit Judges

 

Two of three appeals court judges hearing Bristol Myers Squibb and Janssen’s appeal questioned whether Medicare’s drug price negotiation program was truly structured in a way that gives manufacturers a choice not to participate.

Lytenava: England Becomes First to Fund Ophthalmic Bevacizumab For Wet AMD

Lytenava: England Becomes First to Fund Ophthalmic Bevacizumab For Wet AMD

 

Up to 40,000 people could be set to access Outlook Therapeutics’ Lytenava in England, according to health technology assessment institute NICE, which found the drug for wet age-related macular degeneration had similar health benefits to aflibercept and ranibizumab, and similar costs to aflibercept.

Australian Industry Strikes Deal On Deferred PBS Submissions, Challenges Govt's Capacity Claim

Australian Industry Strikes Deal On Deferred PBS Submissions, Challenges Govt's Capacity Claim

 

Medicines Australia has expressed skepticism over the Pharmaceutical Benefits Advisory Committee’s claim that in March 2025 it will only be able to assess 32 submissions from companies that want to get their drugs subsidized under the Pharmaceutical Benefits Scheme.

Medicare Negotiations: Industry Makes Headway At Appeals Court With First Amendment Argument

Medicare Negotiations: Industry Makes Headway At Appeals Court With First Amendment Argument

 

Judges on the Third Circuit panel in the BMS and JNJ IRA cases seemed sympathetic to industry’s concerns about the government using the term “maximum fair price” in the IRA’s Medicare drug price negotiation program.


Guidance Requires Health Insurers to Cover All PrEP Drugs

Guidance Requires Health Insurers to Cover All PrEP Drugs

 
• By 

Along with the much heralded guidance requiring coverage of OTC birth control, the Biden Administration also required insurers to cover pre-exposure prophylaxis (PrEP) for prevention of HIV.

Medicare Plans Should Halt Off-Label Avastin Step Therapy Amid Supply Disruption, CMS Told

Medicare Plans Should Halt Off-Label Avastin Step Therapy Amid Supply Disruption, CMS Told

 
• By 

The leading supplier of repackaged off-label Avastin for ophthalmic uses is discontinuing the product. Is this the beginning of the end for a relatively cheap wet AMD treatment?

Updating The IRA Math: Not As Bad For Pharma As It Looked?

Updating The IRA Math: Not As Bad For Pharma As It Looked?

 

The landmark drug pricing reforms from the Inflation Reduction Act are starting to take full effect – and it turns out that the impact may not be as dramatic as originally projected based on updated analyses from the US Congressional Budget Office.

Weight Loss Drug Coverage Will Not Pay For Itself, US CBO Affirms

Weight Loss Drug Coverage Will Not Pay For Itself, US CBO Affirms

 

The US Congressional Budget Office acknowledged that weight loss drug coverage could drive long term savings from ancillary health issues, but not enough to offset the cost of the drugs. Expanding Medicare coverage would cost the US Treasury $35 billion over 10 years.


Medicare Part D Cost Sharing Relief Driving Surge In Specialty Drug Prescribing – UnitedHealth

Medicare Part D Cost Sharing Relief Driving Surge In Specialty Drug Prescribing – UnitedHealth

 
• By 

A manufacturer information campaign is increasing awareness about the Inflation Reduction Act provisions easing cost sharing obligations for high-cost drugs in Part D, the insurer said.

Pink Sheet Podcast: SubQ Drugs And Price Negotiations, GLP-1s In Court, US FDA Approach To Black Box AI

Pink Sheet Podcast: SubQ Drugs And Price Negotiations, GLP-1s In Court, US FDA Approach To Black Box AI

Pink Sheet reporter and editors discuss an emerging pharma strategy to avoid Medicare price negotiations, legal wrangling related to compounding GLP-1 drugs for obesity and diabetes, and the varying opinions of FDA officials on the acceptability of artificial intelligence models that are not fully explainable.

What’s The Diagnosis? US CMS Still Prefers Not To Know

What’s The Diagnosis? US CMS Still Prefers Not To Know

 

The US Medicaid agency will not require diagnostic codes on prescriptions any time soon after hearing “overwhelming” opposition from stakeholders.

Independent Pharmacies Present Medicare Negotiated Drug Access Obstacles

Independent Pharmacies Present Medicare Negotiated Drug Access Obstacles

 
• By 

Pharmacy benefit managers are not the only ones in the supply chain that may not feel incentivized to encourage patient access to Medicare negotiated drugs.


340B And Price Negotiation: US Medicare Washes Its Hands Of The Issue

340B And Price Negotiation: US Medicare Washes Its Hands Of The Issue

 

The US Centers for Medicare and Medicaid Services is counting on “good faith” between manufacturers and covered entities to ensure appropriate 340B pricing is offered on drugs subject to the new negotiation authority.

Keytruda, Opdivo SubQ Conversions Cloud Near-Term Medicare Negotiation Savings Forecasts

Keytruda, Opdivo SubQ Conversions Cloud Near-Term Medicare Negotiation Savings Forecasts

 
• By 

A growing number of future Part B candidates for Medicare price negotiation may avoid price controls in the program with injectable versions.

PBM Reform Legislation: PhRMA ‘Laser Focused’ On Passage This Year

PBM Reform Legislation: PhRMA ‘Laser Focused’ On Passage This Year

 
• By 

But the prospects for attaching the legislation to a federal spending package in December will be dependent on the outcome of the upcoming elections.

For Generic Manufactures, New Medicare Drug Pricing Demo Is a Dud

For Generic Manufactures, New Medicare Drug Pricing Demo Is a Dud

 

The proposed CMS innovation center's $2 drug list model will not address the barriers to newer generics getting on Part D formularies and plans may have little incentive to participate in the demo, an industry group said.