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Cathy Kelly

Senior Writer

Washington, DC

Cathy has covered US regulation and reimbursement policy for the biopharma industry since 2004, starting with the establishment of the Medicare Part D program. Since then, she has written extensively about developments in all major sectors of the US insurance market (Medicare, Medicaid and commercial plans). She has covered key legislation affecting biopharma, including the Medicare Prescription Drug, Improvement, and Modernization Act which created Part D, health care reform under President Obama, and the Inflation Reduction Act which establishes a government price negotiation program in Medicare for the first time and redesigns of the Part D benefit.

She has closely followed the increasing influence of pharmacy benefit managers and their use of formulary negotiations and rebates to control pricing. Cathy also has covered developments in health technology assessments, including the growing influence of the Institute for Clinical and Economic Review, and has monitored industry progress on novel drug contracting that reflects value-based pricing.

She has worked as a health care reporter and editor while raising three daughters. Cathy lives outside DC in Bethesda, MD, with her husband Sean.

Latest From Cathy Kelly

GLP-1 Coverage Restrictions In Medicare Part D Surge As Demand For Obesity Drugs Grows

A major shift from unfettered coverage to prior authorizations was recorded by MMIT over the past year for the leading GLP-1/GIP agonist diabetes drugs. Public interest in using the drugs off label for weight loss drove the change.

Reimbursement Medicare

Medicare Reimbursement For Part B Drugs Is 48% Above 340B Prices To Hospitals, MedPAC Finds

New study updates past commission analyses and highlights the significant margin between Medicare payments for drugs and the prices paid by 340B-eligible providers.

Reimbursement Medicare

Xtandi Pricing and Patents: Alternatives To March-In Urged To Lower Medicare, Medicaid Costs

The timing of the request, with Xtandi’s loss of exclusivity on the horizon, could be explained by the concern that a change in the US presidential administration in 2025 may limit the prospects for near-term relief.

Intellectual Property Reimbursement

Medicare-Negotiated Drugs May Not Get Favorable Coverage In Part D: Will CMS Intervene?

Insurance plans put on notice that CMS is concerned about restrictions on drugs with negotiated prices, but it’s not clear what the agency can or will do about it.

Pricing Strategies Reimbursement

Medicare Spending Forecast For Leqembi Reflects CMS Angst About Alzheimer’s Drug Costs

The agency’s projection that Medicare will spend $3.5bn on Leqembi in 2025 is nearly three times the level of sales that marketer Eisai is expecting for the drug in North and South America combined in its fiscal year 2026.

Reimbursement Medicare

Biosimilar Substitution In Medicare Part D Formularies Mid-Year Established In Final Rule

Policy may be helpful in promoting acceptance of follow-ons in Medicare but is not expected to result in near-term savings to the program.

Biosimilars Reimbursement
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