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When the current Part B drug reimbursement scheme – average sales price plus an additional 6% to cover administration and storage – was developed, there was little competition in most of the covered therapeutic categories, Scott Gottlieb, MD, Food and Drug Administration commissioner, said May 15 at an event hosted by the Alliance for Health Policy.
The situation is different now. “Not only are these product categories multisource and in some cases quite crowded, but there is also a lot of therapeutic equivalence,” Dr. Gottlieb said. “There are a lot of other types of drugs [physicians] might use to try to address the same clinical condition.”
He specifically noted that autoimmune and inflammatory conditions have a wealth of products that address them in different ways, with the opportunity for therapeutic substitutions. He also mentioned drugs that are delivered through durable medical equipment as another area open to being moved into a more price-competitive space.
“I don’t think anyone envisioned how competitive these categories would become,” he said.
Switching drug coverage from Medicare Part B to Part D is just one of more than 50 proposals contained in a broad package introduced by the White House on May 11 to address the rising prices of prescription drugs.
“In situations where you have a lot of therapeutic variety ... you have [insurance] plans negotiating pricing using formularies and using things like step therapy, putting drugs on preferred tiers relative to the price concessions they are able to extract,” Dr. Gottlieb said.
In contrast, the current Part B [program], “looks like the small molecule world with respect to how much competition we see within some of these categories, but you don’t have the same structure. Times have changed, and I think that is why you see Secretary [Alex Azar of the Health & Human Services department] rethinking how we bid out those Part B drugs into a competitive scheme.”
Dr. Gottlieb suggested that more competition could come from the moving coverage to Medicare Part D or possibly through a reinvigorated competitive acquisition program for Part B.
When the current Part B drug reimbursement scheme – average sales price plus an additional 6% to cover administration and storage – was developed, there was little competition in most of the covered therapeutic categories, Scott Gottlieb, MD, Food and Drug Administration commissioner, said May 15 at an event hosted by the Alliance for Health Policy.
The situation is different now. “Not only are these product categories multisource and in some cases quite crowded, but there is also a lot of therapeutic equivalence,” Dr. Gottlieb said. “There are a lot of other types of drugs [physicians] might use to try to address the same clinical condition.”
He specifically noted that autoimmune and inflammatory conditions have a wealth of products that address them in different ways, with the opportunity for therapeutic substitutions. He also mentioned drugs that are delivered through durable medical equipment as another area open to being moved into a more price-competitive space.
“I don’t think anyone envisioned how competitive these categories would become,” he said.
Switching drug coverage from Medicare Part B to Part D is just one of more than 50 proposals contained in a broad package introduced by the White House on May 11 to address the rising prices of prescription drugs.
“In situations where you have a lot of therapeutic variety ... you have [insurance] plans negotiating pricing using formularies and using things like step therapy, putting drugs on preferred tiers relative to the price concessions they are able to extract,” Dr. Gottlieb said.
In contrast, the current Part B [program], “looks like the small molecule world with respect to how much competition we see within some of these categories, but you don’t have the same structure. Times have changed, and I think that is why you see Secretary [Alex Azar of the Health & Human Services department] rethinking how we bid out those Part B drugs into a competitive scheme.”
Dr. Gottlieb suggested that more competition could come from the moving coverage to Medicare Part D or possibly through a reinvigorated competitive acquisition program for Part B.
When the current Part B drug reimbursement scheme – average sales price plus an additional 6% to cover administration and storage – was developed, there was little competition in most of the covered therapeutic categories, Scott Gottlieb, MD, Food and Drug Administration commissioner, said May 15 at an event hosted by the Alliance for Health Policy.
The situation is different now. “Not only are these product categories multisource and in some cases quite crowded, but there is also a lot of therapeutic equivalence,” Dr. Gottlieb said. “There are a lot of other types of drugs [physicians] might use to try to address the same clinical condition.”
He specifically noted that autoimmune and inflammatory conditions have a wealth of products that address them in different ways, with the opportunity for therapeutic substitutions. He also mentioned drugs that are delivered through durable medical equipment as another area open to being moved into a more price-competitive space.
“I don’t think anyone envisioned how competitive these categories would become,” he said.
Switching drug coverage from Medicare Part B to Part D is just one of more than 50 proposals contained in a broad package introduced by the White House on May 11 to address the rising prices of prescription drugs.
“In situations where you have a lot of therapeutic variety ... you have [insurance] plans negotiating pricing using formularies and using things like step therapy, putting drugs on preferred tiers relative to the price concessions they are able to extract,” Dr. Gottlieb said.
In contrast, the current Part B [program], “looks like the small molecule world with respect to how much competition we see within some of these categories, but you don’t have the same structure. Times have changed, and I think that is why you see Secretary [Alex Azar of the Health & Human Services department] rethinking how we bid out those Part B drugs into a competitive scheme.”
Dr. Gottlieb suggested that more competition could come from the moving coverage to Medicare Part D or possibly through a reinvigorated competitive acquisition program for Part B.