TV Ad Drug Price Rule Finalized

The HHS Centers for Medicare and Medicaid Services has finalized a rule requiring direct-to-consumer TV ads for prescription drugs covered by Medicare or Medicaid to include the list price — defined in the rule as the wholesale acquisition cost — if that price is equal to or greater than $35 for a month’s supply or the usual course of therapy.

An agency statement defends use of the list price, saying it matters to patients because many of them either pay the list price or prices based on the list price. “For the 47% of Americans who have high deductible health insurance,” the statement says, “the price they see in ads is essentially the price they pay, until they meet their deductible. All seniors on Medicare Part D have coinsurance for certain types of drugs, which means their out-of-pocket expenses are calculated as a share of list price. List prices are also what patients pay if a drug is not on their insurance formulary.”