Presentation (CTI)

OBJECTIVES: CMS commenced negotiations with manufacturers for the first 10 Part D drugs selected for the Drug Price Negotiation Program (DPNP) in early 2024. This analysis aimed to assess how payers are considering new strategies related to formulary decisions, benefit design, cost control measures, and contracting negotiations in response to the release of the initial 10 drugs for DPNP.
METHODS: Health plan medical and pharmacy directors and pharmacy benefit managers were recruited to participate in a double-blinded online survey and interviews in June 2024. Respondents represented national and regional plans. Survey and interview questions focused on expected reactions to DPNP, Part D Redesign, and Medicare Prescription Payment Plan (M3P). Descriptive statistics were reported.
RESULTS: Representatives from 23 payers, including 13 national and 10 regional plans, representing over 300 million lives, completed the survey and/or an interview. In response to DPNP, most payers plan to add utilization management (UM) requirements, particularly for high-cost products. Additionally, 78% plan to use more generics and biosimilars and limit therapeutic options. Over 80% plan to tighten formularies by excluding products and decreasing the number of products on formulary by therapeutic class. 38% plan to develop and use novel UM tools within formularies. Most plans (96%) intend to use DPNP-negotiated prices to benchmark commercial business prices. Most payers (78%) believe M3P will increase prescription adherence rates (78%) while also increasing the operational burden on pharmacies (92%). 67% only intend to meet CMS’s basic requirements for beneficiary outreach and education regarding M3P.
CONCLUSIONS: Survey results suggest payers anticipate increasing management of higher-cost drugs, as well as employing greater control measures and narrowing formularies in response to the initial 10 drugs selected for price negotiation.