Medication Management
Expert articles and analysis related to medication management.
AI Summary — Last 30 Days
CMS drug-payment and utilization-management policy is becoming a more central VBC lever, with stakeholders pushing back on pending CMS pricing models for drugs while analysts focus on how negotiated Part B drug effectuation and proposed drug prior authorization changes could reshape incentives for MA plans, providers, and manufacturers. Medicaid is also moving into medication-based population health strategy: Indiana’s planned GLP-1 coverage for select Medicaid members under the BALANCE model signals that states may use targeted obesity and cardiometabolic drug access as a value-based benefit design tool, even as payers face high medical-cost trend and risk-pool pressure. For ACOs, MA organizations, and health systems, the strategic tension is shifting from “whether to cover” high-cost therapies to how formularies, rebates, prior authorization, and outcomes accountability are aligned across Medicare Part D/Part B and Medicaid models—especially as rebate reallocation decisions after final Part D benchmarks compress plan strategy windows (Wakely; Avalere).
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