Drug Pricing & Pharmacy
Expert articles and analysis related to drug pricing & pharmacy.
AI Summary — Last 24 Hours
CMS data show 4.3 million Medicare beneficiaries—including 3.1 million Medicare Advantage drug plan enrollees and 1.2 million stand-alone PDP enrollees—will see their plans terminated at the end of 2026, with another 1.4 million MA enrollees facing plan consolidations, creating near-term member-retention, medication-continuity, and risk-adjustment disruption for MA organizations, ACO partners, pharmacies, and care management teams during open enrollment (KFF analysis). At the same time, CMS is moving against 340B spread-pricing dynamics through proposed reimbursement cuts, intensifying the margin-versus-access tension for safety-net providers and contract pharmacies while reinforcing payer and federal scrutiny of pharmacy reimbursement flows (HealthLeaders). For VBC stakeholders, the combined signal is that pharmacy economics—Part D benefit stability, formulary disruption, 340B reimbursement, and generic/specialty drug pricing distortions—will increasingly affect total-cost-of-care performance, adherence, and beneficiary experience metrics.
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Missouri AG told Lilly to stop forcing hospitals to provide claims data to receive discounted medicines under 340B, a sign more states are pushing back against drugmakers.
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Novartis CEO Vas Narasimhan said Tuesday that launching new drugs in the private market or in a self-pay market in Europe is not off the table in response to the so-called most favored nation policy. ...
CMS Takes Aim at 340B Spread Pricing with Proposed Reimbursement Cuts
CMS Takes Aim at 340B Spread Pricing with Proposed Reimbursement Cuts  HealthLeaders Media
CMS Takes Aim at 340B Spread Pricing with Proposed Reimbursement Cuts
CMS Takes Aim at 340B Spread Pricing with Proposed Reimbursement Cuts  HealthLeaders Media