Cost & Affordability
Expert articles and analysis related to cost & affordability.
AI Summary — Last 7 Days
CMS is pushing affordability through both drug-payment reform and MA quality economics: the new GLOBE drug payment model signals continued CMMI interest in tying payment to lower specialty-drug spending, while 2027 Star Ratings show more MA-PD members in 4+ star contracts, positioning plans for larger 2028 rebates that can fund supplemental benefits but also intensify scrutiny of MA overpayments and coding. At the same time, MA plan availability varies widely by county, with some major insurers retrenching, creating uneven local affordability and network dynamics that ACOs, health systems, and risk-bearing provider groups will need to factor into 2027 contracting and population-health strategies. Medicaid affordability pressures also remain active under the 2025 reconciliation law, raising state-by-state exposure for coverage and utilization shifts that could spill into uncompensated care and VBC attribution stability.
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