Provider Networks & IPAs
Expert articles and analysis related to provider networks & ipas.
AI Summary — Last 7 Days
Provider networks, IPAs, and ACO-aligned specialists are facing a tighter 2027 economics picture as CMS proposes only a 2.4% Medicare outpatient/ASC base update while Part D pressures continue, including CMS’s move to end the Part D premium stabilization demonstration and signals of ongoing bid pressure—raising downstream risks for referral networks, ambulatory strategy, and total-cost-of-care contracts. Medicaid and specialty VBC models are also moving toward more explicit pharmacy-cost integration: Indiana plans GLP-1 coverage for select Medicaid members under the BALANCE model, while oncology stakeholders are emphasizing that value-based myeloma and cancer care must account for innovation adoption, biosimilars, benefit-channel shifts, and access equity rather than simple unit-price trend (HFMA on 2027 outpatient payments; Wakely on oncology spending trends).
Related Articles
Negotiated Part B Drug Effectuation Proposals: Four SDRA Approaches and Key Tradeoffs
HRSA sets 2027 launch for the 340B rebate model, announces requirements
The Health Resources and Services Administration (HRSA) followed through with plans to pilot a rebate model for the 340B Drug Pricing Program beginning Jan. 1, 2027. As described in a notice published...
Trump administration tries again to institute rebates in 340B
The Health Resources and Services Administration is again pushing to include rebates in the drug discount program after a failed attempt earlier this year. Hospitals railed against the announcement, s...
The government is forcing PBMs to be more transparent, but will reforms make a difference?
The Consolidated Appropriations Act, passed in February, included several significant reforms for PBMs.
How hospitals can prepare for heightened 340B oversight
Momentous change may be looming for the 340B Drug Pricing Program, currently managed by the Health Resources & Services Administration (HRSA). An ongoing debate regarding the program’s effectiveness r...
STAT+: Trump administration revises rebate pilot for 340B drug discount program, angering hospitals
The Trump administration is revising its rebate pilot for the 340B drug discount program, angering hospitals.
The Collision Of 340B Pricing And Medicare Drug Price Negotiation
The Collision Of 340B Pricing And Medicare Drug Price Negotiation Health Affairs
The same 10mg Zepbound costs $449 or $699
By JOHN SAMARAS Eli Lilly sells a month of 10mg Zepbound for $449 through LillyDirect, its own pharmacy. That price holds only if you refill within 45 days of your last fill.Continue reading...
Negotiated Part B Drug Effectuation Proposals: Four SDRA Approaches and Key Tradeoffs - advisory.avalerehealth.com
Negotiated Part B Drug Effectuation Proposals: Four SDRA Approaches and Key Tradeoffs advisory.avalerehealth.com
The Trump Administration’s Deals With Pharma: Policy Progress Or Political Theater?
The Trump Administration’s Deals With Pharma: Policy Progress Or Political Theater? Health Affairs