American Society for Pharmacy Law: Trends in Drug Spending, Pricing, and Pharmacy Reimbursement

Alan Arville, Member of the Firm, Chris Smith, Senior Counsel, and Spreeha Choudhury, Associate, co-present “Trends in Drug Spending, Pricing, and Pharmacy Reimbursement” at the American Society for Pharmacy Law Developments in Pharmacy Law Seminar, which runs from November 3 to November 6.

Federal and state lawmakers have renewed efforts to implement policies that address drug spending and pricing following a temporary toll on such efforts through the height of the pandemic. These renewed efforts are vast and impact all levels of the payer and supply chain. This presentation provides a background overview on recent trends in prescription drug spending and pricing and then focus on the impact these trends may have on pharmacy reimbursement, separate and apart from any impact on patients or payers. Specific emphasis is placed on the Centers for Medicare and Medicare’s (CMS’) 2021 Medicare Advantage and Part D Final Rule, which seeks to reform pharmacy direct and indirect remuneration (DIR) in Medicare Part D.

Alan, Chris, and Spreeha discuss how this Final Rule is likely to impact pharmacy reimbursement. Other topics include:

• State efforts to carve pharmacy benefits back into Medicaid fee-for-service
• Medicaid managed care reimbursement trends, including reimbursement floor mandates for Medicaid MCOs, trends in reimbursement models for drugs, and various state legislative and regulatory measures imposing limitations on pharmacy benefit managers (PBMs)
• Policies contained within recent federal legislative packages, including possible changes to the National Average Drug Acquisition Cost (NADAC) survey process

For more information, please visit ASPL.org.