Good Day BIO: CMS will apply pharmacy price concessions at point of sale

Last week brought positive developments from CMS on reducing patients’ out-of-pocket spending, and BIO’s Dr. Michelle explains why investors should “take a fresh look” at biotech to meet ESG goals. Plus, the new episode of the I am BIO Podcast explores the impact of Alzheimer’s disease—and how biotechnology is offering hope (and possibly a vaccine). (704 words, 3 minutes, 31 seconds)

Victory for patients: CMS will apply pharmacy price concessions at point of sale

After unsuccessful regulatory attempts to lower Medicare Part D beneficiary cost sharing, Centers for Medicare & Medicaid Services (CMS) will at last finalize a proposal to apply pharmacy price concessions at the point of sale—notable progress in BIO's on-going efforts to reduce beneficiary out-of-pocket spending, BIO’s Dan Durham and Andrew Cosgrove told us.

The news: On Friday, Centers for Medicare and Medicaid Services (CMS) issued the final rule revising Medicare Advantage (MA) and Part D regulations for 2023, which will apply pharmacy price concessions at the point of sale beginning in 2024.

The impact: CMS estimates this will save beneficiaries $26.5 billion over 2024-2032.

CMS agreed with BIO’s assessment that applying such concessions at the point of sale does NOT violate Part D’s “Noninterference Clause,” which forbids the government from “interfering in price negotiations in Part D.” The change only specifies where the discount is applied, not the amount, and may have implications for further policy initiatives to reduce beneficiary out-of-pocket spending.

BIO supports this—as well as all such concessions, including negotiated rebates, at the point of sale as a way to lower beneficiary cost sharing. BIO will continue to advocate for this change to further reduce patient prescription out-of-pocket costs.

The final exchange rule (or Notice of Benefits and Payment Parameters) was also a positive step for patients—with a requirement that insurers offer standardized health plan options alongside any non-standardized Qualified Health Plans (QHPs), specifically flat copays for drugs on all tiers of coinsurance.

Additionally, the final NBPP strengthens the enforcement of policies against discrimination in plans. Insurers and pharmacy benefit managers are warned not to design plans that discriminate against people with chronic health conditions by placing all or most drugs to treat a certain condition at the highest tier.

BIO’s long advocated for this change—as well as regulations that prohibit discriminatory benefit design that harm the sickest patients who need the high-value treatments their doctors prescribe. This requirement will limit patient copays and allow for more drugs to be accessed outside of a deductible.

More Reading: What are PBMs, anyway?

‘ESG investors shouldn’t ignore biotech’s potential to deliver change,’ says BIO’s Dr. Michelle

“Traditional sectors such as agriculture, energy, manufacturing, and transportation will be the most important industries for ESG investing,” writes BIO President and CEO Dr. Michelle McMurry-Heath in Fortune—and investors would be wise to “take a fresh look” at biotech.

“ESG investing is rapidly becoming a driving engine of the entire financial industry,”writes BIO’s Dr. Michelle McMurry-Heath. “More than $120 billion poured into sustainable investments in 2021, up from $51 billion in 2020, which itself was a 25-fold increase since 1995.” 

And for a lot of companies, it’s not optional: “The EU will soon require companies to publicly disclose their impact on sustainability. The Securities and Exchange Commission is considering similar regulations for U.S. fund managers.”

Enter biotech—which is “emerging at the forefront of the effort to fight climate change and to develop environmentally sound and sustainable products and techniques in areas such as agriculture and waste control,” she says.

She highlights several BIO member companies and innovative partnerships—developing technologies like microbes that can replace traditional fertilizers, fully biodegradable packaging, sustainable jet fuels, and much more.

Read and share the whole thing.

President Biden’s Tuesday: ICYMI, yesterday he announced a $3 billion plan to boost domestic production of batteries for electric vehicles. Today, he’s heading to Alabama to visit a Lockheed Martin facility and give remarks on security assistance to Ukraine. The Supreme Court has voted to strike down Roe v. Wade, according to the draft opinion obtained by POLITICO—the first time a draft decision has been “disclosed publicly while a case was still pending.”

What’s Happening on Capitol Hill: The Senate is expected to vote on the America COMPETES Act and the United States Innovation and Competition Act (USICA), which address China’s competitiveness, and Senate committees will begin a number of budget hearings.