The Health Care Reform Corner – From the editors of "The Pink Sheet" Nov. 3, 2009
What are policymakers and stakeholders in Washington saying and doing about health care reform? In this periodic BioPharma Today feature, the editors of "The Pink Sheet" and "The Pink Sheet" DAILY highlight some of the major developments chronicled in those publications.
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The Health Care Reform Corner – From the editors of "The Pink Sheet" Nov. 3, 2009
WASINGTON, D.C. – The health care reform bill unveiled by the House leadership Oct. 29 seeks increased drug savings for the Medicare Part D program through mandated rebates for products provided to low-income beneficiaries and by requiring HHS to negotiate drug pricing directly with manufacturers.
The bill, H.R. 3962, is a melded product that combines legislation approved in mid-July by the House Energy and Commerce, Ways and Means, and Education and Labor Committees. It incorporates subsequent revisions agreed upon by House Democrats during closed meetings over the past two months. Read the story here….
House Speaker Nancy Pelosi, D-Calif., achieved her goal of prodding House leaders to develop a unified health reform bill but did not get quite get the public plan option she sought: the bill contains a public plan option using rates negotiated by HHS, but not based on Medicare pricing.
Under the merged bill, HHS would design and implement the option for a public coverage plan. In establishing payment rates and enrollee premiums, HHS would seek recommendations from the American Academy of Actuaries, though the agency ultimately would be in charge of negotiating payments for the public option for health care providers and prescription drugs. Pharma stakeholders have opposed a public plan due to concerns of government price setting. Read the story here….
Innovator biologics may be in for added pricing pressure from biosimilars under Medicare Part B payment and billing code requirements in the House health reform bill.
The bill would require that biosimilars designated by FDA as "interchangeable" with the reference biologic be included in the same billing code as the innovator. Payment amounts would be a blend of the average sales price for the two products. That could pull down the payment amount for the reference product, assuming the biosimilar has a lower ASP. Read the story here….
- Scott Steinke
