A lot of people are framing today’s list as choices CMS made. That’s a bad framing.
Congress gave very explicit instruction to CMS about how to select drugs. There isn’t a lot of wiggle room.
We summarized the selection rules in our simulation:
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There’s some limitations to this process. Mainly, if a drug doesn’t currently have generics but will soon, that isn’t enough for CMS to skip the drug.
Even if doing so would be good strategically.
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For biologics with biosimilar competition expected within 2 years, the companies could have requested a delay.
But apparently that didn’t happen for Novolog or Stelara. I’m not sure why not.
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@bnrome
The selection criteria do at least allow Pharma to reach peak sales revenue before negotiation
✅ Negotiation only allowed 7 years after FDA approval (or 11 for biologics)
With biosimilar entry timed right this could extend to 9 and 13 respectively
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@bnrome
Totally agree. There’s not much discretion for CMS here. They have to stick to a very clear set of parameters
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