Provider Networks
Expert articles and analysis related to provider networks.
AI Summary — Last 30 Days
CMS is tightening the infrastructure around Medicare Advantage networks and drug-spend accountability, proposing public provider-directory accuracy scores for MA plans alongside PBM transparency and flat-fee compensation limits—moves that would make network adequacy, steerage, and pharmacy economics more auditable for VBC contracts. At the same time, CMMI’s finalized GLOBE drug payment model pushes “most-favored nation” pricing into Part B, creating a direct tension between federal drug-price benchmarking, provider-administered drug margins, 340B dynamics, and specialty-care network participation, with PhRMA already suing the Trump administration over the model. For ACOs, MA plans, and health systems, the strategic signal is clear: CMS is pairing value-based payment with harder oversight of the enabling infrastructure—accurate networks, transparent pharmacy incentives, and lower-cost therapeutics—while stakeholders reposition around legal, operational, and contracting exposure (MA directory/PBM proposals, GLOBE model finalized).
Related Articles
CMS finalizes model that aims to bring most-favored nation pricing to Part B
CMS finalizes model that aims to bring most-favored nation pricing to Part B Fierce Healthcare
STAT+: Trump’s watered-down Medicare drug pricing rule saves 96% less than initial proposal
WASHINGTON — The Trump administration published a final rule aimed at lowering Medicare prices for drugs administered in doctor offices. It applies to only four companies. The Global Benchmark for…
CMS sets GLOBE ‘most favored nation’ Medicare drug price model
CMS sets GLOBE ‘most favored nation’ Medicare drug price model Modern Healthcare
CMS finalizes GLOBE Medicare demo but savings trail projections
The Centers for Medicare and Medicaid Services finalized a demonstration program aimed at lowering the prices of drugs in Medicare, but with significantly lower expected savings than previously projec...
The pharmacy pays $1,302. The patient pays $299
By JOHN SAMARAS A US retail pharmacy pays $1,302 to acquire one month of branded Wegovy. That figure comes from the Centers for Medicare and Medicaid Services National Average Drug Acquisition CostCon...
Hospitals are scrambling to keep 340B discounts. Here’s what to know
Hospitals are scrambling to keep 340B discounts. Here’s what to know Modern Healthcare News
STAT+: Pharmalittle: We’re reading about a plan to lower Medicare drug prices, a Lilly obesity drug, and more
A final Medicare rule aimed at lowering prices for doctor-administered drugs applies to only four companies and saves 96% less than the initial proposal
Pharma Pulse: EU's Pharma Package and Specialty Drug Tariff Exemptions
Waltz Health, Fresenius Kabi partner for direct-to-payer biosimilar program
Waltz Health, Fresenius Kabi partner for direct-to-payer biosimilar program Fierce Healthcare
GLP-1s spur a new calculation of healthcare value
The core tension in the policy debate around GLP-1 drugs is whether to view the products merely as a high-cost pharmacy benefit or more holistically through the prism of population health. In some way...