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"Dollars for Donuts" Deal Revisited: What Pharma Got

This article was originally published in RPM Report

Executive Summary

A Kaiser Family Foundation report on the impact of the Medicare Part D donut hole reads like an artifact of history. But it helps quantify the benefit to brand name industry from closing the donut hole in the context of health care reform.

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Part D: “Very Successful” Does Not Mean “Perfect”

Medicare’s Jonathan Blum says Part D has been a success but says there are areas where improvements could be made. CMS will continue to emphasize access, but is paying more attention to over-utilization in some categories.

The Supreme Court and Biosimilars: What if it All Goes Away?

After the bruising health care reform debate in Congress, biopharmaceutical companies were comfortably on the periphery of the legal arguments playing out in the Supreme Court. But being peripheral has its disadvantages: if the Court sides with the challengers, it is possible that one of the “peripheral” provisions tossed aside will be the new biosimilars pathway. That would be a disaster for innovator companies.

The New Part D: "Dollars for Donuts" Becomes Discounts For Data

The pharmaceutical industry's 50% donut hole discount worked out exactly as planned in the context of shaping the health care reform debate. The implementation of the new program is a different story. The program created by CMS doesn't look anything like industry would have hoped-but manufacturers have no choice but to play by CMS' rules, and try to make it work for them anyway.

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