Pharmacy & Medication Management
Expert articles and analysis related to pharmacy & medication management.
AI Summary â Last 30 Days
Medication management is moving deeper into payment-model design as CMS under the Trump administration advances CY2027 Medicare Advantage/Part D policy changes and drug prior authorization reforms, while states test affordability tradeoffsâmost notably Indianaâs plan to cover GLP-1s for selected Medicaid members under the BALANCE model. For VBC stakeholders, the strategic tension is shifting from âcoverage vs. exclusionâ to managed access: aligning high-cost drugs, cardiometabolic risk reduction, oncology innovation, and prior authorization with measurable outcomes, equity, and total-cost accountability rather than pharmacy spend alone. Recent analyses of CMS drug prior authorization proposals and oncology spending trends underscore that ACOs, MA plans, Medicaid agencies, and specialty providers will need more sophisticated forecasting and benefit-channel management as innovation, biosimilars, and utilization controls reshape risk.
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