Drug Pricing
Expert articles and analysis related to drug pricing.
AI Summary — Last 30 Days
Drug-pricing activity is shifting from broad inflation control toward operationally complex payment-model implementation: Medicare Advantage and Part D sponsors are preparing for negotiated Part B drug prices, NAMBA/base premium-driven rebate reallocation, and tighter CMS pricing-model exposure that could affect benefit design, bids, and provider contracting in 2026–2027. At the same time, biotechs are lobbying the Trump administration’s CMS/HHS leadership to pull back pending pricing models, while Medicaid stakeholders are evaluating new federal pharmacy demonstrations—creating a strategic tension between lower public-program drug spend and preserving access, innovation incentives, and outcomes-based contracting flexibility for VBC entities. MA plans, ACO-aligned specialists, and risk-bearing providers should treat drug pricing as a bid, formulary, and total-cost-of-care issue—not just a pharmacy trend—particularly as Part B negotiated prices move closer to implementation (Avalere; [CHCS](https://news.google.com/rss/articles/CBMitAFBVV95cUxOSlVNMW5YaElQXzQtTVJaWXctS1QzUjh3Rm43NHppaTFfRTJkRC1BTDN6eEJ6OThZT2VTVHhXRGdhckdsSGNVcGRkQkFsTmlLWVAt
Related Articles
Revised Model Legislation: An Act to Reduce Prescription Drug Costs Using Medicare Maximum Fair Price (MFP) Reference-Based Pricing
View NASHP’s updated model legislation using Medicare maximum fair prices as upper payment limits with savings validation and public comment. The post Revised Model Legislation: An Act to Reduce Presc...
Q&A: Revised Model Legislation: An Act to Reduce Prescription Drug Costs Using Medicare Maximum Fair Price Reference-Based Pricing
Learn how this model act uses Medicare's negotiated drug prices as reference rates to help states reduce prescription drug costs. The post Q&A: Revised Model Legislation: An Act to Reduce Prescription...
How Foreign Reference Pricing Embeds Valuations And Risks Undermining Global Innovation
That is the title of my new Health Affairs Forefront piece out today with Lou Garrison and Richard Xie. An excerpt from the article is below: United States policy makers increasingly argue that Americ...
Pharmaceutical Manufacturer response to Most Favored Nation (MFN): Delay, Hide or Confuse?
Today I attended the very interesting ISPOR Health Policy Leadership Exchange (HPLE) in Washington DC on the topic of Most Favored Nation (MFN). There were a number of important points made and I’ll s...
Extending Medicare Maximum Fair Prices for Drugs to State Markets
NASHP’s updated model legislation helps states use Medicare drug prices as reimbursement caps to lower commercial drug costs. The post Extending Medicare Maximum Fair Prices for Drugs to State Markets...
Medicare Drug Price Negotiation Program Proposed Rule Summary
HFMA provides a detailed summary of the proposed rule to codify the Medicare Drug Price Negotiation Program (“Negotiation Program”) and establish certain new policies for the Negotiation Program and t...
CMS Proposes Rule to Govern the “Medicare Drug Price Negotiation Program”
CMS Proposes Rule to Govern the “Medicare Drug Price Negotiation Program” King & Spalding
STAT+: Pharmalittle: We’re reading about a broader $35 insulin cap, a former FDA cancer drug chief, and more
The search for affordability wins is leading U.S. senators back to capping the cost of insulin at $35 in the private insurance market and for the uninsured
Florida launches probe into CVS for alleged anticompetitive pharmacy practices
The investigation by Florida’s attorney general comes as states look to check pharmacy benefit managers for allegedly driving up drug costs.
How payers, drugmakers can collaborate to drive more outcomes-based contracts
How payers, drugmakers can collaborate to drive more outcomes-based contracts Fierce Healthcare