Total Cost & Affordability
Expert articles and analysis related to total cost & affordability.
AI Summary — Last 7 Days
CMS’s affordability agenda this week is converging on two fronts: aggressive drug-cost intervention and renewed Medicare Advantage scrutiny. All 50 states applied for CMS’s GENEROUS Model, which would test most-favored-nation Medicaid drug pricing and projects $64.3B in savings—material for Medicaid managed care plans, state purchasers, and VBC entities bearing pharmacy trend risk (AJMC). At the same time, MA remains under fiscal pressure as MedPAC defended its $76B overpayment estimate while CMS Administrator Dr. Mehmet Oz described MA as a “garden” vulnerable to “weeds and overgrowth,” signaling that plans and provider groups in MA risk arrangements should expect continued oversight of coding intensity, benchmarks, and program value (Healthcare Dive).
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