Pharmacy Access
Expert articles and analysis related to pharmacy access.
AI Summary — Last 30 Days
Pharmacy access is being reshaped by a mix of CMS drug-pricing implementation, Medicaid coverage experimentation, and payer bid strategy: Indiana’s plan to cover GLP-1s for select Medicaid members through the BALANCE model signals a move toward targeted obesity-drug access tied to population-health and budget controls, while Medicare Advantage and Part D plans are preparing for negotiated Part B drug prices and rebate reallocations that could alter formularies, supplemental benefits, and provider-administered drug economics. The strategic tension for VBC stakeholders is clear: CMS under the Trump administration is pushing affordability and fiscal oversight, while biotechs and plans are positioning around whether pricing models, NAMBA/BBP benchmarks, and negotiated-drug effectuation will constrain innovation, shift costs across benefits, or create new access inequities for oncology, GLP-1, and specialty-drug populations. See: [Indiana GLP-1 Medicaid BALANCE model](https://news.google.com/rss/articles/CBMivAFBVV95cUxPdXVqMmptLWg3dkRsME5uMzhMZGJMNmJVV3J1TzVvUHZjUlo5ZE9iTlFBNmNmMEs2NHFpU1NoT2JscWtCOEtScnJCRTY2aU82cVNiNE1OZG85al9MR1hZa0xvdVBZZlhZSFk1d1
Related Articles
CMS proposes 340B cuts
A proposed rule would cut the rates by which Medicare pays hospitals for 340B drugs by more than a third, reviving a similar policy introduced by the first Trump administration. CMS said on Thursday...
STAT+: Lawmakers urge HHS to force Eli Lilly to provide 340B drug discounts to hospitals
Lawmakers step into a dispute between Eli Lilly and hospitals about the 340b drug discount program.
Court halts Colorado price cap on Amgen's blockbuster Enbrel
US District Court Judge Daniel Domenico in Colorado granted Amgen's preliminary injunction to stop a 70% price cap on its blockbuster autoimmune drug Enbrel, arguing that the cap could cause "economic...
STAT+: U.S. judge blocks Colorado’s first-of-its-kind price cap on an Amgen drug
A federal judge blocked a Colorado state panel from placing a cap on the price of Enbrel, a blockbuster drug sold by Amgen
How did Washington State’s PDAB select drugs?
Many policymakers are looking for ways to reduce drug spending. Federal policymakers are not the only ones looking at the issue. In recent years, state Prescription Drug Affordability Boards (PDABs) h...
Part B Negotiated Drug Prices: How MA Plans Should Prepare
Tampa General sues Eli Lilly over pulled 340B discounts
Tampa General sues Eli Lilly over pulled 340B discounts Becker's Hospital Review
Prime Therapeutics, Express Scripts face price-fixing allegations
Prime Therapeutics, Express Scripts face price-fixing allegations Modern Healthcare
Tampa General kicks off legal fight over Lilly's 340B restrictions
Tampa General Hospital sued Eli Lilly for halting its 340B discounts, kicking off a broader fight over whether pharmaceutical companies can condition drug discounts on new claims data requirements. ...
Judge blocks Colorado’s 1st-in-nation drug price cap
Judge blocks Colorado’s 1st-in-nation drug price cap Becker's Hospital Review