Pharmacy Access
Expert articles and analysis related to pharmacy access.
AI Summary — Last 7 Days
Pharmacy access pressures are shifting from formulary coverage to affordability mechanics: under the Trump administration, CMS plans to end the Part D premium stabilization demonstration, raising the risk of sharper 2027 premium movement just as plans absorb IRA redesign, negotiated-drug implementation, and Medicare Prescription Payment Plan uptake challenges (Healthcare Dive). At the same time, Indiana’s planned Medicaid GLP-1 coverage under the BALANCE model and ongoing debate over Part B negotiated-drug effectuation signal a broader move toward selective, model-based access for high-cost therapies—putting ACOs, Medicaid MCOs, and specialty providers under more pressure to manage medication adherence, total-cost trend, and equity in access rather than treating pharmacy as a carve-out (Becker’s Payer Issues
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
The rise and consequences of PBM vertical integration
Decades ago, PBMs were independent operators, but now, the biggest ones are vertically integrated with healthcare conglomerates.
What appeals court 340B rebate decision means for federal rebates
An appeals court barred 340B rebate programs by drug manufacturers, among recent legal developments. The case could have ramifications for federal 340B rebates. On July 21, the U.S. Court of Appeals f...
Drug pricing and the IRA: Tracking the government's negotiation power
Drug pricing and the IRA: Tracking the government's negotiation power Endpoints News
A Prescription for Drug Costs: Inject Transparency and Improve Accessibility
A Prescription for Drug Costs: Inject Transparency and Improve Accessibility MedCity News
Brand Drugmakers’ Patent Abuse Is Raising Americans’ Healthcare Costs by Billions Each Year
Brand Drugmakers’ Patent Abuse Is Raising Americans’ Healthcare Costs by Billions Each Year AHIP
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