Payment Integrity & Affordability
Expert articles and analysis related to payment integrity & affordability.
AI Summary â Last 7 Days
Medicare Advantage affordability and payment integrity pressures are converging: SCANâs expanded Costco partnership is positioning retail distribution and lower-friction plan shopping as a counter-move while larger insurers pull back from MA markets, raising questions about whether new consumer channels can improve competition without worsening risk selection or benefit complexity (AAF, Fierce Healthcare). At the same time, scrutiny is intensifying around MA transparency, prior authorization friction, and vertical integrationâespecially hospital-affiliated insurers potentially using regulatory design to extract higher taxpayer paymentsâwhile Epicâs instant prior authorization checks suggest payers and providers are moving toward workflow-level automation to reduce administrative waste and protect margins in value-based care.
Related Articles
MFP Effectuation and the SDRA: The Possibility of ASP Spirals in Competitive Drug Classes[
Federal appeals court revives part of Teva's IRA case as Austedo price cuts loom
After a lower court rejected Teva's case last fall, a federal appeals court has revived part of the drugmakerâs lawsuit against Medicare negotiations. The DC Circuit Court ruled on Tuesday that Teva...
Response to Senate Finance Committee request for information on policies for lowering drug prices
Response to Senate Finance Committee request for information on policies for lowering drug prices  Brookings
Comments on the Medicare Drug Price Negotiation Program proposed rule for IPAY 2029
Comments on the Medicare Drug Price Negotiation Program proposed rule for IPAY 2029Â Â Brookings
Legislative Proposals Aim to Modify the 340B Program
STAT+: The White House declares âpromises made, promises keptâ on lowering drug prices. Nice try
In its effort to lower drug prices, the White House has declared "promises made, promises kept." That's a narrative that doesn't reflect the full story.
Trump is taking credit for lower list prices. But a Biden-era law did a lot of the heavy lifting
List prices for brand-name drugs have declined significantly in 2026. But the reasons behind it may have more to do with a Biden-era law than any of the Trump administration's recent initiatives, expe...
Businesses increase support for hospital price caps
Business groups increasingly support various approaches to cap hospital prices. Although many business groups continue their traditional opposition to any government price controls, an increasing numb...
Beyond Point Solutions: Chronic Condition Support for Total Cost of Care
Beyond Point Solutions: Chronic Condition Support for Total Cost of Care  AHIP
AHA comments on CMS proposal to codify Medicare Drug Price Negotiation Program regulations
AHA comments on CMS proposal to codify Medicare Drug Price Negotiation Program regulations  American Hospital Association