This article originally appeared in Health Affairs.
By Nigel Rawson and John Adams, February 9, 2024
The Centers for Medicare and Medicaid Services (CMS) has the new role of negotiating prescription drug prices for Medicare under the Inflation Reduction Act. CMS will begin with a group of 10 medicines and has to decide what the price should be relative to the drug’s benefits (all 10 drugs have been approved in the US since at least September 2017). CMS’s decision is to be based on the drug’s therapeutic advance compared with existing treatment alternatives and the costs of the current treatment options.
In a recent article in Health Affairs Forefront, John Lin and colleagues discussed approaches to health technology assessment (HTA) and price negotiation in three other high-income countries (Canada, France, and Germany) to see what lessons can be learned from them. Here, we argue that Canada’s HTA process is not a model for CMS going forward because of its lack of flexibility, limited patient and provider input, lack of transparency, inadequate accountability, and poor track record of timely decision making.