Pharmaceuticals & Drug Pricing

Synthesis:

In the past week, CMS finalized major changes to 2027 Medicare Advantage and Part D policies, including revisions to drug pricing and benefit design directly impacting risk-bearing entities, plan sponsors, and value-based care providers—highlighting ongoing regulatory momentum on pharmacy benefit reforms (HFMA summary). At the same time, CMS proposed new rules to require electronic prior authorization for drugs across both medical and pharmacy benefits, with the aim of streamlining utilization management and improving medication access for Medicare and Medicaid populations—a move that would further enable integrated, VBC-aligned pharmacy models (HFMA e-PA proposal). Amid these developments, the agency delayed the Part D component of the BALANCE Model for GLP-1 expansion, reflecting ongoing payer-provider tensions around coverage for high-cost therapies under value-based frameworks.