Pharmacy & Drug Pricing
Expert articles and analysis related to pharmacy & drug pricing.
AI Summary — Last 7 Days
CMS is moving to institutionalize Medicare drug price negotiation through a permanent framework, while also advancing drug prior authorization interoperability standards—signaling that pharmacy cost control is becoming more operationalized inside Medicare and Medicaid payment infrastructure, not just handled through one-off pricing actions. At the same time, KFF’s analysis of Medicare Advantage rebate dynamics underscores a growing market imbalance: MA-PD plans can use MA rebates to suppress Part D premiums and cost sharing, accelerating pressure on stand-alone PDPs and complicating ACO and payer strategies for medication affordability, adherence, and beneficiary retention. For VBC stakeholders, the week’s pattern is clear: drug pricing, pharmacy benefit design, and prior authorization workflows are increasingly tied to total-cost-of-care performance and beneficiary steering, especially as CMS considers a permanent Medicare negotiation framework.
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The IRA Fixed One Medicare Part D Distortion—But Patients Now Face New Tradeoffs
By Bryce Platt, PharmD For years, Medicare Part D plans often preferred high-list/high-rebate branded multiple sclerosis (MS) drugs over lower-cost generics. That was rational behavior inside an irra...
CMS Proposes Permanent Rules for Medicare Drug Price Negotiation
Agencies issue proposed rule codifying Medicare Drug Price Negotiation Program
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340B rebate model pilot advances as providers warn of added costs
The Health Resources and Services Administration (HRSA) continues to take steps toward implementing a rebate model for the 340B Drug Pricing Program. After soliciting comments on a planned model over ...
CMS seeks to close Medicare negotiation 'loophole'
CMS has proposed a policy change that clarifies its stance on how products are grouped together for Medicare negotiations. Under the Inflation Reduction Act, biologics become eligible for Medicare n...
STAT+: FDA approves Colorado’s plan to import cheaper drugs from Canada
The FDA said it will allow Colorado to import certain prescription drugs from Canada in an effort to bring prices down for residents.
CMS proposes permanent framework for Medicare drug price negotiations
CMS proposes permanent framework for Medicare drug price negotiations Fierce Healthcare