Pharmacy & Drug Pricing
Expert articles and analysis related to pharmacy & drug pricing.
AI Summary — Last 30 Days
CMS under the Trump administration is moving GLP-1 coverage from a formulary-by-formulary payer decision into a more centralized Medicare access intervention, launching $50/month beneficiary access to selected obesity drugs after July 1—an approach that may begin as a temporary bridge but could create durable expectations for Medicare coverage, risk adjustment, and population-health ROI in obesity management (CMS GLP-1 launch; STAT analysis). For ACOs, MA plans, Medicaid agencies, and employers, the core tension is no longer whether GLP-1s are clinically valuable—ICER and others frame them as cost-effective—but whether total-budget exposure is manageable when obesity prevalence exceeds 40% of adults, especially under capitated or shared-savings arrangements. At the same time, CMS’ drug prior-authorization interoperability rulemaking and renewed scrutiny of MA rebate-driven Part D advantages point to a broader structural shift: pharmacy benefit design is becoming a central lever in VBC strategy, affecting adherence, coding, beneficiary selection, and the competitive stability of stand-alone Part D plans ([KFF on MA rebates and Part D](https://www.kff.org/
Related Articles
Medicare Drug Price Negotiation is here to stay
At least, it won’t be overturned by the US Supreme Court. Endpoints reports: The Supreme Court says it won’t wade into the pharma industry’s yearslong legal battle over Medicare drug price negotiation...
STAT+: Trump’s drug-pricing deals set to be tested by new product launches
The public is about to get its first look at the prices of drugs launched since President Trump struck his most-favored-nation deals with 17 drugmakers.
[World Report] Are Trump's drug pricing policies saving anyone money?
Experts question the effectiveness of the Trump administration's strategies to cut pharmaceutical costs in the USA. Washington Correspondent Susan Jaffe reports.
Vertical integration doesn’t appear to lead to higher drug costs in Medicare, HHS OIG finds
However, data was limited, so it’s too early to make firm conclusions, the watchdog clarified. That didn’t stop the largest PBM lobby from jumping on the report as concrete proof that consolidation do...
Virginia governor vetoes prescription drug pricing bills
Where PBM reform stands across the US
Opinion: The innovation trap: How pharma weaponizes a word to extend monopolies
“Just because a company invests does not mean it has invented anything novel,” Tahir Amin and Rohit Malpani write in this excerpt from “Pharma Monopoly.”
NCPA Says HHS OIG Report Raises Important Questions
STAT+: Virginia governor vetoes legislation to create an advisory panel to lower the cost of prescription drugs
Virginia's governor vetoed a closely watched effort to create an advisory panel to lower prescription drug costs.
Manufacturer-Sponsored Coupon Use and Brand-Name Drug Costs Among Patients With Insurance
Manufacturer-Sponsored Coupon Use and Brand-Name Drug Costs Among Patients With Insurance JAMA