Payer Contracting & Networks
Expert articles and analysis related to payer contracting & networks.
AI Summary — Last 30 Days
CMS is tightening the strategic link between network/payment-model participation and unit-cost control: the 2027 Ambulatory Specialty Model participant list signals continued use of mandatory or quasi-mandatory specialty episodes, while Mathematica’s joint-replacement analysis reinforces that episode-based contracting can reduce Medicare spending without quality erosion when providers manage post-acute utilization and implant/site-of-care variation. At the same time, Medicare Advantage plans are retrenching for 2027—cutting offerings while CMS Administrator Dr. Mehmet Oz signals continued oversight of MA “weeds and overgrowth”—raising pressure on ACOs, specialists, and health systems to reassess payer mix, referral networks, and downside-risk exposure as MA networks narrow and benefits normalize (MA plan cuts; Oz on MA oversight). Medicaid is also moving toward more centralized purchasing leverage through CMS’s GENEROUS most-favored-nation drug pricing model, with participating states applying, which could reshape pharmacy economics for Medicaid MCOs, safety-net systems, and value-based pharmacy arrangements tied to chronic disease management.
Related Articles
Federal policymaking is reshaping the 340B environment as health systems prepare for 2027
Federal policymaking is reshaping the 340B environment as health systems prepare for 2027Â Â Chartis
Subscription Drug Pricing: The Evidence Behind It Comes From Two States, And They Disagree. - healthaffairs.org
Subscription Drug Pricing: The Evidence Behind It Comes From Two States, And They Disagree.  healthaffairs.org
STAT+: How Trump’s latest pharma deals may undermine efforts to rein in drug costs
Analysts say private deals involve drugmakers agreeing to lower prices in Medicaid, where prices are low, in return for no price cuts in Medicare.
Administration announces a new set of drug pricing agreements
Administration announces a new set of drug pricing agreements  American Hospital Association
Three takeaways from Trump's latest drug pricing event
President Donald Trump announced voluntary drug pricing deals with nine new companies on Monday, for the first time veering outside of the original crop of companies that he singled out in letters las...
Mid-cap biotechs join Trump’s latest round of drug pricing deals
Focused on Medicaid, the new pacts now involve more than just large pharmaceutical companies.
Federal policymaking is reshaping the 340B environment as health systems prepare for 2027
Federal policymaking is reshaping the 340B environment as health systems prepare for 2027Â Â Chartis
The Drug Price Paradox: PBMs, Pharmacies, and the Path to Affordability
Subscription Drug Pricing: The Evidence Behind It Comes From Two States, And They Disagree.
Subscription Drug Pricing: The Evidence Behind It Comes From Two States, And They Disagree.  Health Affairs
Issues and potential policy directions in Part D - medpac.gov
Issues and potential policy directions in Part DÂ Â medpac.gov