Drug Pricing & Part D
Expert articles and analysis related to drug pricing & part d.
AI Summary — Last 7 Days
CMS is pushing drug-cost accountability into both Medicaid and utilization-management infrastructure: the Trump administration extended the manufacturer application deadline for the CMMI GENEROUS Model after strong pharma interest, while separately proposing electronic prior authorization standards for drugs across medical and pharmacy benefits—an operational shift that could reduce friction for Part D, MA-PD, and specialty-drug management but also expose payer variation in access controls. At the same time, VBC stakeholders are converging on high-cost therapeutic categories—GLP-1s, oncology, advanced therapies, and specialty pharmacy—where coverage expansion, outcomes-based contracts, and care-management wraparounds are becoming central to affordability strategies, especially as Part D plans and ACO-aligned providers face pressure to manage total cost of care without bluntly restricting access. The key tension is whether CMS-led models and digital PA rules can move drug management from rebate/prior-auth gatekeeping toward measurable outcomes and longitudinal medication management, or simply create new compliance burdens for plans, health systems, and manufacturers.
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