Anthem Denies Coverage For Eteplirsen, Citing Lack Of Clinical Efficacy
The move to deny coverage for an approved orphan drug is ‘highly unusual,' NORD VP says. 'We certainly hope this isn’t going to set a precedent.'
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As MACPAC moves toward formal recommendations, a CBO analysis finds that differential Medicaid rebates for drugs approved through the accelerated pathway could save the federal government up to $1bn over five years.
CDER Director Woodcock says pricing and approval issues are becoming "conflated" but it is hard to change people's minds when they are "determinedly angry about something."
States are eager to try more aggressive methods to rein in prescription drug costs under Medicaid, and CMS is willing to be flexible in permitting innovative contracting. But the agency is also quietly but firmly making clear that all FDA-approved drugs have to be treated the same.