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Medicare Rule Change Delays Price Negotiation for AbbVie's Creon, Impacting Drug Costs

Medicare Rule Change Delays Price Negotiation for AbbVie's Creon, Impacting Drug Costs

A recent report by the consumer advocacy group Public Citizen highlights a change in Medicare's drug age calculation that has delayed price negotiation for AbbVie's drug Creon by seven years. This change, proposed to be made permanent by the current administration, affects Creon, a pancreatic enzyme replacement product used by over 185,000 Medicare beneficiaries. The Inflation Reduction Act of 2022 allows Medicare to negotiate drug prices, but only after a drug has been on the market for a specified period. Creon was reclassified as a biologic in 2020, resetting its eligibility clock for price negotiation. This delay means Creon will continue to be sold at manufacturer-set prices, impacting Medicare's spending.
Rochester Democrat and Chronicle Rochester Democrat and Chronicle
Medicare costs could soon increase for 1.3M New Yorkers. Here's why

Medicare costs could soon increase for 1.3M New Yorkers. Here's why

The Trump administration says it's planning to end the program a year earlier than initially planned because it's "no longer needed."
Westchester County Journal News Westchester County Journal News
Why Medicare costs could soon increase for 1.3 million New Yorkers

Why Medicare costs could soon increase for 1.3 million New Yorkers

The Trump administration says it's planning to end the program a year earlier than initially planned because it's "no longer needed."
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LUGPA Advocates for Medicare Reforms and Expanded Cancer Care Access

LUGPA Advocates for Medicare Reforms and Expanded Cancer Care Access

The Large Urology Group Practice Association (LUGPA) is actively advocating for several healthcare policy reforms, focusing on improving access to cancer treatments and ensuring high-quality care for veterans. LUGPA supports the Precision Oncology Program for Cancer of the Prostate (POPCaP) Authorization Act, which aims to expand veterans' access to precision oncology and telemedicine services. Additionally, LUGPA is involved in efforts to reform Medicare payment systems, advocating for permanent reforms tied to the Medicare Economic Index to better reflect rising practice costs. The organization is also opposing restrictive insurer step therapy requirements that delay treatment for cancer patients. LUGPA's advocacy includes engaging with Congress and the Centers for Medicare & Medicaid Services (CMS) to influence policy changes that support independent physician practices and reduce administrative burdens.
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HRSA Revives 340B Rebate Pilot Program Amid Medicare Price Negotiation Changes

HRSA Revives 340B Rebate Pilot Program Amid Medicare Price Negotiation Changes

The Health Resources and Services Administration (HRSA) has announced a revised 340B Rebate Model Pilot Program, which will require participating manufacturers to provide 340B pricing through rebates instead of upfront discounts for certain drugs selected for the Medicare Drug Price Negotiation Program's 2026 and 2027 price applicability years. This move follows a decision by the D.C. Circuit in Novartis v. Kennedy, which confirmed that rebate models are permissible under Section 340B but require approval from the Department of Health and Human Services (HHS). The revised pilot aims to address concerns about duplicate discounts and provide better visibility into individual transactions. Eligible manufacturers must submit rebate plans by August 24, 2026, with the program set to take effect on January 1, 2027.
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Arizona Health Insurance Companies Seek Significant Rate Increases Amid Rising Costs

Arizona Health Insurance Companies Seek Significant Rate Increases Amid Rising Costs

Health insurance companies in Arizona's Affordable Care Act (ACA) marketplace are proposing an average premium increase of 25% for 2027. These rate increase requests were filed with the Arizona Department of Insurance and Financial Institutions in May and made public recently. The filings indicate that six out of seven insurers in Arizona's ACA market are seeking substantial rate hikes, citing a worsened risk pool due to the expiration of enhanced premium tax credits. The proposed increases range from 3% to nearly 34%, with Antidote Health requesting the lowest increase. The insurers attribute the need for higher rates to anticipated increases in medical spending, prescription drug costs, and changes in the health risk pool. The Centers for Medicare & Medicaid Services (CMS) expects a drop in ACA enrollment, which could lead to a 3% increase in premiums nationally for 2027.
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HRSA to Launch 340B Rebate Pilot as Congress Considers Reform Legislation

HRSA to Launch 340B Rebate Pilot as Congress Considers Reform Legislation

The Health Resources and Services Administration (HRSA) has announced plans to implement a 340B rebate model pilot program starting January 1, 2027. This pilot will allow drug manufacturers to apply the 340B ceiling price to certain drugs sold to covered entities through a rebate mechanism. Concurrently, multiple legislative efforts are underway in Congress to reform the 340B program. The SUSTAIN 340B Act, introduced by a bipartisan group of senators, aims to end rebate model programs and establish a clearinghouse for managing prescription-level data. The SECURE 340B Act, introduced in the House, seeks to pause rebate models and establish new standards for contract pharmacies and data transparency.
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Portland Psychiatrist Criticizes Prior Authorization for Delaying Patient Care

Portland Psychiatrist Criticizes Prior Authorization for Delaying Patient Care

Dr. Jeffrey S. Barkin, a psychiatrist in Portland, Maine, has voiced strong criticism against the practice of prior authorization required by insurance companies. In a recent opinion piece, Dr. Barkin described an incident where he prescribed a generic medication for a patient, only to be met with a demand for prior authorization from the insurer. This process, intended to prevent unnecessary treatments, often results in delays and additional administrative burdens for doctors. Dr. Barkin argues that this system turns physicians into clerks and patients into individuals waiting for permission to receive care. He highlights that the administrative costs often exceed the cost of the medication itself, making the process not only inefficient but morally wrong.
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Latigo Biotherapeutics Develops Non-Opioid Pain Treatments

Latigo Biotherapeutics Develops Non-Opioid Pain Treatments

Latigo Biotherapeutics Develops Non-Opioid Pain Treatments
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Medicare Policy Shift Delays AbbVie Drug’s Price Negotiation by Seven Years, Advocacy Group Claims

Medicare Policy Shift Delays AbbVie Drug’s Price Negotiation by Seven Years, Advocacy Group Claims

An advocacy group has highlighted a significant policy shift by Medicare that has resulted in a seven-year delay in the price negotiation eligibility for a major AbbVie drug. This change, which was not widely publicized, affects the timeframe in which the drug can be nominated for federally negotiated prices. The Inflation Reduction Act of 2022 had previously granted Medicare the ability to negotiate prices for select costly medications to make them more affordable. However, the recent policy shift extends the period before this particular drug can be negotiated, potentially impacting pharmaceutical spending and drug accessibility for millions of Americans. The advocacy group argues that this delay could lead to continued high prices, affecting Medicare's overall drug spending and out-of-pocket costs for beneficiaries.
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Bayview Patients Report Unclear Medicare Charges for Care Management

Bayview Patients Report Unclear Medicare Charges for Care Management

Patients of Bayview Physicians Group have reported unexpected monthly charges for Medicare's Advanced Primary Care Management (APCM) program, which they do not recall consenting to. The program, which began in 2025, allows practices to bill Medicare for care coordination services. Some patients, like Joleen Zackowski and William Wright, have expressed confusion and concern over the charges, noting no noticeable change in their care. The Centers for Medicare & Medicaid Services require providers to obtain patient consent and inform them of potential costs, but patients claim they were not adequately informed.
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PALTmed Supports PURE Act to Improve Medicare Reimbursement for Portable Ultrasound

PALTmed Supports PURE Act to Improve Medicare Reimbursement for Portable Ultrasound

PALTmed has expressed strong support for the Portable Ultrasound Reimbursement Equity (PURE) Act, which aims to close a gap in Medicare policy by ensuring reimbursement for portable ultrasound transportation and set-up services. Introduced by a bipartisan group of lawmakers, including Reps. Beth Van Duyne, Brad Schneider, Mariannette Miller-Meeks, and Lori Trahan, along with Sens. John Cornyn and Maggie Hassan, the bill seeks to provide better access to timely diagnostics for patients, reducing the need for travel to medical facilities.