Summary
Following the collapse of the Build Back Better Act (BBBA), it remains unclear whether Congress will pass drug pricing legislation. While it is still possible for Congress to act on separate components of the BBBA (including drug pricing) via reconciliation, there is less insight into how exactly Democrats plan to move forward on these legislative priorities. It has remained WHG’s perspective that, if Congress does not act on drug pricing, the Biden Administration may exercise waiver authority available through the Center for Medicare and Medicaid Innovation (CMMI) to advance demonstration models that address drug costs.
Due to the uncertainty around BBBA and whether Congress will coalesce around a drug pricing package, WHG has prepared a brief memorandum that outlines the potential types of models CMMI could advance absent legislative action on drug pricing. The range of possible models are derived from comments that the Administration has offered in recent publications, notably including its Comprehensive Plan for Addressing High Drug Prices, as well as CMMI’s Strategy Refresh White Paper. We break this possible range of models down into the following sub-categories for further consideration:
- Adjustments CMMI could make to existing models;
- New model concepts; and
- Models that employ concepts previously attempted but ultimately rescinded by CMMI.
In addition to overviewing what these models could include, we also offer brief commentary on the potential timing for when the Biden Administration could move forward on each of these models if it chooses to do so.