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September 19, 2018

Meet the Rebate, the New Villain of High Drug Prices

A growing chorus, including the Trump administration, is calling for a rethinking of after-the-fact drug discounts that some say contribute to rising prices. An increasingly popular culprit in the debate over high drug prices is the pharmaceutical rebate, the after-the-fact discounts that form the heart of the nation’s arcane — many would say broken — market for prescription drugs. Click here to read more

September 19, 2018

Addressing Out-Of-Pocket Specialty Drug Costs In Medicare Part D: The Good, The Bad, The Ugly, And The Ignored

The cost of prescription drugs in the United States has been a popular topic of debate in recent years, particularly when it comes to specialty drugs with very high price tags. High-profile proposals and reports—including this year’s President’s Budget; the National Academies of Science, Engineering, and Medicine’s report on making medicines affordable; the Medicare Payment Advisory Commission (MedPAC) annual report to Congress; and the recent Department of Health and Human Services (HHS) Blueprint to Lower Drug Prices and Out-of-Pocket Costs—have made a variety of recommendations, leading to a flurry of reactions from all segments of the health care industry. Click here to read more

September 19, 2018

Safe Harbor Sunshine And Flat Fees: Vital Steps Towards Smarter Drug Spending

The Trump Administration’s Health Care Blueprint, released in May, raises the possibility of eliminating the Anti-Kickback Statute (AKS) “safe harbor” for Pharmacy Benefit Managers (PBMs). This particular AKS safe harbor transforms illegal “kickbacks” into policy-laundered “rebates.” Critics of the rebate safe harbor claim that it creates a perverse incentive structure, and allows PBMs to demand high rebates and pocket the money – without reducing patient co-pays or co-insurance rates. Read more by clicking here.