Pharmacy Value Management
Expert articles and analysis related to pharmacy value management.
AI Summary — Last 7 Days
CMS is moving pharmacy policy from ad hoc implementation toward more durable value-management infrastructure: proposed rules would codify the Medicare Drug Price Negotiation Program and tighten product-grouping rules to close a negotiation “loophole,” while stakeholders are also pressing CMS on drug prior authorization and interoperability standards that will shape how plans, providers, and ACOs operationalize medication management. At the same time, the Trump administration’s temporary Medicare GLP-1 bridge program—offering weight-loss drugs for $50 after July 1—creates a major new cost and adherence-management pressure point for MA, Part D, and risk-bearing provider organizations if it proves politically difficult to unwind. These developments reinforce a broader shift in Part D incentives, where IRA redesign is changing formulary behavior and rebate economics, but may also create new patient-access and total-cost-of-care tradeoffs for VBC entities managing chronic disease populations. CMS negotiation rule GLP-1 bridge program
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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...
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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
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CMS seeks to close Medicare negotiation 'loophole'
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