Pharmacy Access
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Indiana’s plan to cover GLP-1s for select Medicaid members through the CMMI BALANCE model signals growing state and federal willingness to test obesity-drug coverage inside value-based Medicaid frameworks, but it raises immediate questions about eligibility criteria, longitudinal outcomes measurement, and budget exposure for high-cost chronic weight-management therapies (Becker’s Payer Issues). At the same time, Avalere’s analysis of Medicare negotiated Part B drug “effectuation” options underscores a live operational tension for providers and ACOs: how CMS translates negotiated prices into
Related Articles
Negotiated Part B Drug Effectuation Proposals: Four SDRA Approaches and Key Tradeoffs
The same 10mg Zepbound costs $449 or $699
By JOHN SAMARAS Eli Lilly sells a month of 10mg Zepbound for $449 through LillyDirect, its own pharmacy. That price holds only if you refill within 45 days of your last fill.Continue reading...
Negotiated Part B Drug Effectuation Proposals: Four SDRA Approaches and Key Tradeoffs - advisory.avalerehealth.com
Negotiated Part B Drug Effectuation Proposals: Four SDRA Approaches and Key Tradeoffs  advisory.avalerehealth.com
Cigna CEO: Express Scripts seeing 'significant early interest' from clients for new rebate-free PBM model
Cigna CEO: Express Scripts seeing 'significant early interest' from clients for new rebate-free PBM model  Fierce Healthcare
Indiana plans to cover GLP-1s for some Medicaid members under BALANCE model - beckerspayer.com
Indiana plans to cover GLP-1s for some Medicaid members under BALANCE model  beckerspayer.com
Cost comparison of efanesoctocog alfa vs conventional factor VIII therapies for major surgeries in patients with severe hemophilia A - ashpublications.org
Cost comparison of efanesoctocog alfa vs conventional factor VIII therapies for major surgeries in patients with severe hemophilia AÂ Â ashpublications.org
First round of Trump's 100% pharma tariffs won't start Friday as planned
Over the past 16 months, the Trump administration’s pharma tariffs have loomed large over the industry. While the first wave of these levies was scheduled to arrive on Friday, July 31, a White House o...
Cancer Medicine Approvals in the US
Cancer Medicine Approvals in the USÂ Â JAMA
Why Some Family Health Insurance Is Now Much Pricier
As 2025 came to a close, health care policy experts—and Americans who could not get insurance through an employer—focused on whether Congress would extend the enhanced Affordable Care Act (ACA) subsid...
Employers are trimming obesity benefits for workers, Cigna says
Employers are trimming obesity benefits for workers, Cigna says  Modern Healthcare