Drug Pricing
Expert articles and analysis related to drug pricing.
AI Summary — Last 30 Days
CMS is pushing drug-pricing reform toward operationalized value-based purchasing: the Trump administration extended manufacturer applications for the Medicaid GENEROUS Model after strong pharma interest, signaling a near-term test of outcomes- or access-linked pricing arrangements between states and manufacturers. At the same time, CMS’ proposed electronic prior authorization rule for drugs would standardize and automate utilization management across medical and pharmacy benefits, a structural shift that could reduce friction for ACOs, specialty pharmacies, and risk-bearing providers managing high-cost therapies while giving payers tighter real-time controls. GLP-1s, advanced therapies, and specialty pharmacy care management remain the strategic pressure points, as Part D risk-adjustment changes and coverage debates force MA-PDs, PDPs, health systems, and manufacturers to align affordability, adherence, and outcomes infrastructure around expensive chronic-disease and specialty-drug categories (GENEROUS Model deadline extension; CMS drug ePA proposal).
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For millions of Americans, accessing the medications they need at prices they can afford has gotten increasingly difficult.
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