The Alphabet Soup of Drug Pricing: Understanding Interactions of ASP, MFP, MFN, 340B, and MDRP
Moderator
Sujith Ramachandran, PhD, University of Mississippi, University, MS, United States
Speakers
Kristi Martin, Camber Collective, Washington, DC, United States; John M Coster, PhD, RPh, Centers for Medicare and Medicaid Services (CMS), Baltimore, MD, United States
Purpose: This year marks the launch of the negotiated prices in the Medicare Drug Price Negotiation Program and introduces another pricing benchmark, the Maximum Fair Price (MFP). There are several other programs in the drug pricing landscape with significant policy changes – such as the 340B rebate model, the most favored nation (MFN) pricing models, and the Medicaid best price guarantee – setting the stage for a complex interplay between these programs and the MFP. These policy changes have the potential to bring more confusion to an already complex and opaque pricing system for manufacturers, health plans, healthcare providers, policymakers, patients, and researchers. Workshop participants will learn the fundamentals of the programmatic updates in the federal drug pricing landscape, identify critical points of interaction between programs, and learn how best to monitor these policies as they unfold.
Description: Ramachandran will provide basics of the drug pricing programs with a brief history of the issue in Medicare, Medicaid, and commercial insurance (10 mins). Martin will summarize the most recent legislative and regulatory updates to these programs – effectuation of MFP, MFN models, 340B rebate model, and the Medicaid best price guarantee (15 mins). Coster will identify points of interactions between programs and identify challenges facing patients, providers, and manufacturers in navigating the new landscape and preview the next year of drug pricing policy including identifying areas for potential reform. (15 mins). Participants will engage with panelists in small group discussions for a series of three case-based simulations in oncology, injectable medication, and a long-acting oral medication. In each case, participants will be make pricing and access decisions using real-time polling as if they were a manufacturer, payer, or provider navigating current policy. (15 mins) Panelists will engage with audience to address questions on the impacts of these policies for patients, providers, and payers. (5 mins)
Topic
Health Policy & Regulatory, Health Service Delivery & Process of Care, Organizational Practices