AcuPartD

Keeping you updated on the latest Medicare and Part D news


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ProPublica Analysis of Open Payments Data

ProPublica’s analysis of Open Payments data found that “me-too drugs” were the most heavily promoted in last five months of 2013. These drugs are generally newer and compete with cheaper, existing therapies, thus the need for aggressive marketing and differentiation.

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While analyzing the data, ProPublica found that drug companies had submitted data with errors ranging from typos to blank fields and incorrect payment categorizations. The data submissions are not checked by CMS, so Open Payments users may encounter missing data or ambiguous payment records. Representatives from the pharmaceutical industry anticipate that future data submissions will go more smoothly. CMS expects to release payments data covering the full year 2014 this June.

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Update: Discrimination Via Prescription Benefit Structures

Update (1/23/2015):

All four of the four Florida insurers included in the complaint have reached agreements with state regulators to make HIV/AIDs medications more accessible, including lowering prices and removing prior authorization restrictions. Most recently, Preferred Medical Plan agreed to cap monthly out of pocket costs at $200 for four HIV/AIDs medications. The US Department of Health and Human Services is still investigating the insurers for potential discrimination.

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Original post (7/11/2014):

The AIDS Institute and the National Health Law Program have filed a complaint against four Florida insurers for discrimination against beneficiaries with HIV/AIDS. The complaint included an analysis of Qualified Health Plan options in Florida, demonstrating how the four insurers were cost outliers that placed HIV/AIDS medications, both brand and generic, in the highest cost-sharing tiers.

Through high cost-sharing, quantity limits, and prior authorization requirements, prescription drug plans could discourage beneficiaries with certain medication needs from enrolling, notably those requiring expensive drugs. Discriminatory benefit designs are illegal on the health insurance exchanges, as well as Medicare Part D, and CMS has said that it will conduct outlier analysis to identify discriminatory benefit designs in Qualified Health Plans.

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FDA Panel Unanimously Recommends Approval of Biosimilar Drug

For the first time, an FDA expert panel has recommended the approval a biosimilar drug, which is a generic version of a biologic drug. The biosimilar, EP2006, is a close copy of the cancer therapy drug Neupogen. EP2006 was approved in Europe in 2009, back when the Untied States lacked a regulatory pathway for biosimilars. However, that framework has been built up since 2010, and EP2006 could open the biologic drug market to lower-cost competition. Biosimilars have the potential for significant savings; according to Express Scripts, biosimilars are generally about a third cheaper than their brand name counterparts, and EP2006 alone could reduce drug costs by $5.7 million over the next decade.

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