Drug Pricing & Access
Expert articles and analysis related to drug pricing & access.
AI Summary — Last 30 Days
The Trump administration’s CMS is intensifying drug-pricing intervention across Medicare and Medicaid, with near-term pressure points around Part B negotiated drug prices, pending CMS pricing models, and new federal pharmacy demonstrations that could reshape MA plan economics, Medicaid pharmacy strategy, and manufacturer contracting behavior. MA organizations and Part D sponsors are positioning for operational volatility—especially rebate reallocation after final NAMBA/base premium benchmarks and Part B negotiated-price implementation—while midsize biotechs are lobbying White House and HHS officials to scale back CMS models they argue could constrain capital formation and pipeline investment. For VBC stakeholders, the strategic issue is whether drug affordability policy becomes more tightly integrated with outcomes-based contracting and total-cost-of-care accountability, or instead creates pricing and access disruption that ACOs, MA plans, and Medicaid programs must absorb through formulary, benefit-design, and care-management changes (Avalere on Part B negotiated drug prices; CHCS on federal pharmacy demonstrations.
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...
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...
STAT+: Lawmakers urge HHS to force Eli Lilly to provide 340B drug discounts to hospitals
Lawmakers step into a dispute between Eli Lilly and hospitals about the 340b drug discount program.
Court halts Colorado price cap on Amgen's blockbuster Enbrel
US District Court Judge Daniel Domenico in Colorado granted Amgen's preliminary injunction to stop a 70% price cap on its blockbuster autoimmune drug Enbrel, arguing that the cap could cause "economic...
STAT+: U.S. judge blocks Colorado’s first-of-its-kind price cap on an Amgen drug
A federal judge blocked a Colorado state panel from placing a cap on the price of Enbrel, a blockbuster drug sold by Amgen
How did Washington State’s PDAB select drugs?
Many policymakers are looking for ways to reduce drug spending. Federal policymakers are not the only ones looking at the issue. In recent years, state Prescription Drug Affordability Boards (PDABs) h...
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...
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
STAT+: Pharmalittle: We’re reading about a court win for Amgen, Novo seeking supplier discounts, and more
U.S. judge blocked a Colorado state panel from placing a cap on the price of Amgen's blockbuster drug Enbrel