At the recent Medicare Policy Summit, Tim Hermes, the Senior Director of Government Affairs for Sepracor, offered an overview of Medicare’s current cost control strategy. These six strategies are part of Medicare’s policies, but are not necessarily applied evenly or consistently.
1. Functional Equivalency: if 2 drugs are deemed to be functionally equivalent, then their average sales price may be linked so they are reimbursed at the same rate.
2. Inherent Reasonableness: CMS has the right to decrease payments for treatments, that are deemed not to be inherently reasonable, by increments of 15% at a time.
3. Widely Available Manufacturing Price (WAMP): when the average sales price of a drug is higher than the WAMP, CMS has the right to reduce the drug’s price to the WAMP.
4. Coverage Restrictions: CMS can choose to restrict coverage for any drug, especially for off-label uses.
5. Judicial Bar: Only Medicare beneficiaries can sue CMS. Manufacturers may not.
6. Congress: there are several committees that have jurisdiction over Medicare, including the Senate Finance Committee, the House Ways and Means Committe, and the House Energy and Commerce committee. Congress can enact legislation to decrease the average sales price of drugs, and can influence Medicare cost control mechanisms.
The Biotechnology Industry Organization (BIO) announced on February 12th the creation of the Biotech Humanitarian Award, to be given to an individual in the field of biotechnology who has enhanced the human experience by harnessing the power of biotechnology to heal, feed or fuel the planet.
The Biotech Humanitarian Award will recognize individuals behind tangible improvements in the area of therapeutics, food and agriculture or industrial and environmental applications. The inaugural award and a prize of $10,000 will be presented in May at the annual BIO International Convention, and the five finalists will be recognized as well. The 2009 BIO International Convention runs May 18-21 in Atlanta, Georgia.
Nominations are open to all individuals and can be accessed via iambiotech.org. Nominees must have achieved one of the following: produced new applications, significantly advanced biotech applications or made available tangible, applicable results in the food and agriculture, industrial and environmental, or therapeutic sectors.
Qualified nominees for the Biotech Humanitarian Award will be professionals in the biotechnology field including scientists, researchers, academics, entrepreneurs, financiers, philanthropists, educators, advocates and others who have added value to society through their pursuit of biotechnology processes.