Pharmacy Value Management

Pharmacy value management pressure is intensifying as Medicare Part D plan economics deteriorate: KFF finds average Part D premiums are set to rise roughly 50% next year, increasing shopping risk for beneficiaries and forcing MA-PD plans, ACO partners, and payer pharmacy teams to revisit formulary design, adherence supports, and total-cost-of-care assumptions during open enrollment (KFF via Healthcare Dive). At the same time, OIG reports that fewer than 25% of Medicaid beneficiaries with hepatitis C received treatment within six months, spotlighting a major gap between curative drug availability and population health execution that Medicaid MCOs, ACO-like arrangements, and safety-net providers will need to close through screening-to-treatment workflows, prior authorization redesign, and pharmacy access interventions (OIG). GLP-1 coverage, biosimilar capacity, and medication affordability platforms remain active fronts, but the immediate VBC implication is clearer: pharmacy strategy is shifting from unit-price management to accountable access, adherence, and outcomes management under rising premium and specialty-drug pressure.