Drug Pricing Reform
Expert articles and analysis related to drug pricing reform.
AI Summary — Last 7 Days
Drug pricing reform attention this week centered on whether CMS/CMMI’s Medicaid-focused GENEROUS Model can generate meaningful net savings beyond already-large statutory and supplemental rebates, with KFF emphasizing that impact will hinge on confidential model design details, state participation, manufacturer behavior, and how savings are measured—key uncertainties for Medicaid managed care plans and state VBC strategies tied to pharmacy trend management (KFF analysis). In Medicare VBC, biosimilar uptake is increasingly framed as a provider-performance issue: ACOs and specialty groups in value-based payment models may have stronger incentives to steer toward lower-cost biosimilars, but adoption depends on formulary design, physician behavior, patient trust, and whether savings flow back to accountable providers (AJMC). At the same time, GLP-1 and specialty-drug cost growth is intensifying pressure on employers, payers, and risk-bearing providers to integrate pharmacy management with primary care, obesity/metabolic health pathways, and population health models rather than treating drug spend as a standalone PBM problem.
Related Articles
A Look at the GENEROUS Model and Factors That Could Impact Medicaid Drug Costs
This issue brief provides background on the GENEROUS model, examines the factors that will contribute to the model’s overall impact on Medicaid drug costs, and illustrates how savings will depend on m...
Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Fourth Quarter of 2025 - Office of Inspector General (.gov)
Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Fourth Quarter of 2025 Office of Inspector General (.gov)
Trump Promised Cheaper Drugs. Some Prices Dropped. Many Others Shot Up.
From newsletter: This Week: There Are Many MAHAs This Week: There Are Many MAHAs Plus, the cost of health care is a more prominent focus for MAHA voters than issues like food and vaccine policy. ͏ ͏ ͏...
CMS to provide Medicare Part D beneficiaries with $50 monthly access to certain GLP-1 medications
CMS to provide Medicare Part D beneficiaries with $50 monthly access to certain GLP-1 medications American Hospital Association
Comments on biosimilar streamlining efforts and context on commercial barriers to competition
Comments on biosimilar streamlining efforts and context on commercial barriers to competition Brookings
MFN Drug Pricing Proposal Raises Questions Around Access, Innovation, and Commercial Coverage
Amgen, AbbVie say IRA negotiations impacted Q1 sales
At least two drugmakers say they’re feeling the impact of the Inflation Reduction Act, after the first drug prices negotiated under the law took effect in January. Amgen and AbbVie reported in their...
STAT+: Administration report on most favored nation drug pricing raises new details — and questions
Administration report on most-favored nation drug pricing raises new details — and questions.
Most Favored Nation Drug Pricing: Anchoring To A Moving Target
Most Favored Nation Drug Pricing: Anchoring To A Moving Target Health Affairs
Amgen’s Retreat: Denmark, Repatha, And The Collision Course Of US MFN Pricing Policy
Amgen’s Retreat: Denmark, Repatha, And The Collision Course Of US MFN Pricing Policy Health Affairs