Pharmacy, PBMs & Pricing
Expert articles and analysis related to pharmacy, pbms & pricing.
AI Summary — Last 30 Days
In the past month, CMS finalized substantial updates for Medicare Advantage and Part D for Contract Year 2027, notably implementing new risk adjustment changes to more accurately separate MA-PDs and PDPs—reshaping plan payments for high-cost conditions and amplifying incentives for population health management and medication adherence strategies (Avalere Health Advisory). The issued 2027 Rate Notice confirms a significant 2.48% average increase in MA payments (revised upwards from the advance notice), which equates to roughly $13 billion in additional funds for plans—creating both opportunities and pressures to align pharmacy, PBM, and clinical integration to deliver value and manage rising drug costs within new benchmarks (Wakely Week in Washington). These structural shifts, coupled with the ongoing implementation of BALANCE to expand access to GLP-1 therapies, are increasing the strategic imperative for payers, ACOs, and providers in risk models to optimize medication management, manage selection risk, and leverage redesigned Part D benefits for population outcomes.
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