Health

Last week, CMS announced the GENEROUS (GENErating cost Reductions fOr U.S. Medicaid) Model. The program basically is a ‘most favored nation’ style reference pricing based on net prices from developed countries. The program builds on the Medicaid Drug Rebate Program (MDRP). Specific details specified on the CMS website include: Participating manufacturers whose applications are accepted…

That is the topic of a recent BioSpace article titled “How Effective Will TrumpRx and Other Direct-to-Consumer Drug Pricing Initiatives Be?” A am quoted in the article as follows: While [direct-to-consumer] DTC has been a growing trend in biopharma for nearly two years now—Lilly launched LillyDirect in January 2024—the number of drugmakers looking to sell their…

Excited to have finished day 1 at ISPOR Europe in Glasgow, Scotland. Come check out my session on Tuesday with Tiago Beck at 11:30-12:00pm. EU Pharmaceutical Package: Where Are We and Where Are We Going? Speakers Tiago Beck, MSc, FTI Consulting, Brussels, Belgium; Jason Shafrin, PhD, FTI Consulting, Los Angeles, CA, United States As trilogue…

While for years patient engagement has been seen as a valuable, starting in 2026 this will be a legal mandate. Plans offering essential health benefits must appoint at least 1 patient representative to their pharmacy and therapeutics (P&T) committees by the start of 2026.1 After July 10, 2026, every state Medicaid program must establish standalone Beneficiary…

That is the question a new paper by Chambers et al. (2025) aims to answer. The authors use data from the Specialty Drug Evidence and Coverage (SPEC) Database, which contains coverage policies related to specialty pharmacy for a large number of US health plans, to examine how n=25 cell and gene therapies are being covered…