Drug Pricing & Part D
Expert articles and analysis related to drug pricing & part d.
AI Summary — Last 30 Days
CMS is pushing drug-pricing policy further into value-based purchasing: the Trump administration extended manufacturer and state applications for CMMI’s Medicaid GENEROUS Model, signaling strong industry interest in outcomes-linked payment for high-cost therapies while keeping pressure on states to operationalize rebate, data-sharing, and performance-measurement infrastructure. In Medicare, the CY 2027 Part D risk-adjustment changes separating MA-PD and PDP payment dynamics will shift plan economics by condition mix, while GLP-1 coverage debates and emerging specialty-pharmacy care-management models are forcing MA plans, ACO-aligned providers, and health systems to decide whether drug spend is a pharmacy-cost liability or a lever for population health outcomes. For VBC stakeholders, the strategic tension is moving from “coverage vs. exclusion” to “who can manage medication outcomes, affordability, and total cost of care well enough to take risk,” especially for obesity, diabetes, specialty drugs, and advanced therapies.
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