Drug Pricing & Pharmacy Benefit
Expert articles and analysis related to drug pricing & pharmacy benefit.
AI Summary — Last 7 Days
Synthesis:
Over the last week, CMS finalized significant 2027 payment policies for Medicare Advantage (MA) and Part D, including a 2.48% average increase in MA plan payments—substantially higher than initially proposed—and finalized updates to the Part D risk adjustment model, which will distinctly impact MA-PDs versus PDPs and alter plan reimbursement structures for specific conditions. The Trump administration is driving further separation between plan categories, aiming to strengthen accountability and long-term sustainability, while CMMI’s BALANCE program remains in focus for its support of expanded access to GLP-1 therapies for obesity—raising new dynamics for drug pricing and pharmacy benefit management within risk-adjusted, value-based models. For VBC stakeholders, these moves signal evolving incentives, sharpened risk adjustment mechanics, and increasing opportunities for targeted population health strategies in MA and Part D. - [CMS Finalizes 2027 MA and Part D Payment Policies](https://news.google.com/rss/articles/CBMi9gFBVV95cUxOSHV6U0FnRERhNTVhclh2NFp3RHAwd0lGWGNfRWlMRDdZT2NLN2E2ZG9fUXZqbjhoTk5oLWN2QmNfM1FqNmNEbmcwVGt0T3FOZU10VWE1elNickprbnpZUTQ2UHY3VUFtaDVVM1lse
Related Articles
change its pharmacy care model
From newsletter: The LI Daily: Ascendiun CEO Paul Markovich wants the industry to back a policy reform movement focused on affordability, tech innovation Ascendiun CEO Paul Markovich wants the indus...
Trends in Manufacturer Coupons for Biologics: Decline in Use Despite Higher Per-Claim Value
Premier Responds to RFI on Potential 340B Rebate Model Pilot Program
Premier raised concerns that a rebate based approach to the 340B drug discount program would undermine the program and create significant risk for hospitals.
Standing up to Rising Prescription Drug Costs Increases Access to Breakthrough Medications
For millions of Americans, accessing the medications they need at prices they can afford has gotten increasingly difficult.
‘Most Favored Nation’ Drug Pricing Is An Idea Whose Time Has Come
‘Most Favored Nation’ Drug Pricing Is An Idea Whose Time Has Come Health Affairs
How health care lobbying distorts the U.S. opioid crisis
KevinMD recently published a paper describing the horrible impacts of health care lobbying in the U.S. This article assesses how effective the lobbyists have been in misdirecting four key legislators ...
In a first, a drugmaker’s lawsuit challenges HRSA’s 340B patient definition
In a new chapter for litigation involving the 340B Drug Pricing Program, a drugmaker is suing the federal government over the definition of patient as it pertains to the program. AbbVie Inc. says the ...
Recent 340B Court Rulings Sustain Blocked WV Law, Demand Decade-Old Federal Policy Be Set Aside
InsideHealthPolicy reports that a federal court ruled in favor of Premier Inc., vacating a decade-old HRSA policy limiting how certain 340B hospitals purchase drugs through group purchasing organizati...
Federal Court Vacates HRSA’s 2013 340B Guidance Prohibiting DSH GPO Use and Replenishment Models
Court vacates 340B policy on hospital drug purchasing: 6 things to know
Becker’s Hospital Review reports that a federal court ruled in favor of Premier Inc., vacating a 2013 HRSA policy restricting 340B hospital drug purchasing after finding the agency failed to adequatel...