Medication Access & Pricing

CMS’ launch of $50-a-month Medicare access to GLP-1s, announced by Administrator Dr. Mehmet Oz, could materially shift Part D utilization, obesity-related population health strategies, and risk-bearing economics for Medicare Advantage and ACO-aligned providers—especially as commercial employers and payers remain split, with reports of Cigna dropping employee GLP-1 coverage. At the same time, drug-cost pressure is intensifying through 340B disputes, as Eli Lilly’s claims-data requirements threaten hospital discounts and ASHP is urging HHS enforcement, creating near-term margin and access risks for safety-net systems participating in VBC contracts. Separately, scrutiny of Medicare overpayment for certain eye injections signals continued opportunity for ACOs and payers to target specialty drug site-of-care, biosimilar, and prescribing variation as high-yield affordability levers.