Healthcare Economist May 13, 2024
See my previous posts on IRA price negotiation on drug selection (Part 1) and manufacturer data submission (Part 2).
Today we will talk about the negotiation process and how CMS will set the maximum fair price (MFP)
How will CMS price across dosages?
“CMS will base the single price on the cost of the selected drug per 30-day equivalent supply (rather than per unit—such as tablet, capsule, injection—or per volume or weight-based metric), weighted across dosage forms and strengths.”
Is there a maximum value or “ceiling” for the maximum fair price (MFP) that CMS will offer?
The maximum MFP amount will be no higher than:
- An amount equal to the sum of the plan-specific enrollment weighted amounts
- The lower...
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