Pharmacy Value Management
Expert articles and analysis related to pharmacy value management.
AI Summary — Last 7 Days
Medicare pharmacy value management is entering a volatility phase: CMS data show 4.3 million beneficiaries will lose MA-PD or stand-alone PDP coverage at the end of 2026, with another 1.4 million MA enrollees in consolidating plans, forcing ACOs, MA partners, and medication-management teams to prepare for formulary disruption, adherence risk, and beneficiary navigation during open enrollment (KFF analysis). At the same time, Part D redesign, IRA drug-price negotiation guidance, and scrutiny of generic market dynamics are intensifying pressure on plan bids, premiums, cost sharing, and rebate/formulary strategy—raising the stakes for VBC organizations that rely on predictable pharmacy access to manage total cost of care (KFF Part D overview). Medicaid pharmacy performance also remains a population-health gap, with HHS OIG finding fewer than 25% of Medicaid beneficiaries with hepatitis C received treatment within six months, underscoring that drug affordability reforms alone do not ensure timely, outcomes-based care delivery.
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