Illustrated by Sarah Grillo/Axios
The next phase of the Biden administration’s efforts to curb rising drug costs is in the hands of a low profile federal agency called the Center for Medicare and Medicaid Innovation (CMMI).
News promotion: The center plans to publish a report within three months on how new payment and delivery models will be used to reduce drug costs and facilitate access to treatment for beneficiaries of two government health programs. . presidential decree From President Biden.
Zoom in: Created through the Affordable Care Act, CMMI is experimenting with new ways to pay for and provide health care.
- Pilot programs typically last for years. Participation is usually voluntary, but in some cases the Center may require the involvement of providers.
- CMMI programs have the potential to become permanent fixtures of Medicare and Medicaid if they prove to save money or improve the quality of care.
Be smart: The center is expected to work on the prices healthcare providers pay for Medicare medicines, such as infusions and injections.under inflation control law, The government cannot negotiate prices for these drugs until 2028.
- By experimenting with price negotiations and payments based on patient health, regulators can learn best practices before the launch date.
- Ropes & Gray attorney and former CMMI employee David Ault said the center could also explore ways to incorporate drug pricing reform into existing projects and various federal payment agencies.
policy improvement Recent congressional action on Medicare prescription drug pricing could also be on the agenda.
- The center could, for example, test an alternative version of Medicare’s $2,000 annual cap on out-of-pocket costs for prescription drugs.
- Stacey Ducetzina, a professor of health policy at Vanderbilt University Medical Center, said that incorporating a monthly spending limit “allows people to avoid paying for everything in one month, after which all treatment is free.” It may become
Flashback: CMMI has attempted to address drug pricing under previous administrations, with mixed success.
- Both the Obama and Trump administrations have failed to conduct experiments to lower Medicare drug costs for health care providers. However, 106 health insurance sponsors now participate in center programs that provide seniors with access to affordable insulin.
Reality check: It may take some time to get the new drug pricing experiment up and running.
- It typically takes 18 months to two years for programs to be approved and implemented, so new drug pricing models are likely not to start until at least 2024, Ault said.
don’t forget: The center’s parent, the Centers for Medicare and Medicaid Services, will continue its own work on drug pricing to implement the Reduced Inflation Act policy.
- Congress has not taken advantage of this argument either. Rachel Sachs, a law professor at the University of Washington in St. Louis, said lawmakers seem eager to keep talking about insulin costs and the practices of pharmacy benefit managers, he told Axios.
Zoom out: We look forward to hearing more from CMMI on drug pricing reform and other federal health policy issues over the next few years.
- “In the last few years of the administration, we often see innovation centers very active and trying to adopt ideas and concepts…even if there is a change in the political parties, it is enough for them to materialize. said Oort.
