Expert: Biden Administration’s Health Care Agenda Looks to Bring ‘More Transparency Into Point of Sale Prices’ for Pharmacies

Pharmacy Times interviewed Neil Lund, senior advisor, Avelere Health and Ryan Urgo, managing director, Health Policy, Avelere Health, on their presentation at the Asembia Summit 2022 titled Evolution of Biden’s Healthcare Agenda in an Election Year.

Question: What are some aspects of Biden’s health care agenda that have impacted the pharmacy field and pharmaceutical industry to date?

Neil Lund: Yeah, I think there are several. One is limitations on taking price increases. Another one, that's very interesting is in Medicaid, the Amcap, which eliminates the 100% limit so that drug manufacturers could actually go negative. Then, the third, that's very controversial for them, is negotiation itself.

Ryan Urgo: Well, on the fourth, but I think the pharmacy impact though, you have on the regulatory side, action on reform of pharmacy on [direct and indirect remuneration (DIR) fees], that's probably worth spending a few seconds.

Neil Lund: It is. On the pharmacy side, that's one where there's a lot of issues around that to be addressed. The proposal itself is fairly simplistic. But it does cost the government money to do that, and it will also change the dynamics for all pharmacies and change them in ways that are hard to predict because plans will try to claw back their losses.

Ryan Urgo: That policy, which was proposed through regulation, would essentially require pharmacy price concessions that are negotiated by plan sponsors to be applied to the negotiated price versus clawed back retrospectively, like manufacturer rebates work. That would create more transparency into what point of sale prices are and also lower the beneficiaries out-of-pocket because the coinsurance would be based on a lower amount. But it also could create premium pressure for plans because they're not retaining those rebates as direct and indirect remuneration.

Question: What has been the impact of the Biden's health care agenda on the pharmacy supply chain?

Neil Lund: Yeah, I don't know that really has—I don't think anything has really had a significant impact on supply chain. I think it has a minor impact on it, but I don't see anything that's significant.

Question: What are some health care issues Biden’s administration is looking to address on the horizon that may impact the pharmacy field?

Neil Lund: I'd say there's an underlying approach to protect the small independent pharmacies. That's a challenge because you're seeing a timeframe when the large chains are actually eliminating some of their outlets and shrinking. So, that's what I'd say has been—I don't know if it's a stated focus or not—but it appears to be the focus.