VBC Market Dynamics
Expert articles and analysis related to vbc market dynamics.
AI Summary — Last 7 Days
VBC stakeholders are seeing a sharper payment-policy split under CMS: Medicare Advantage remains under pressure as MedPAC defends its $76 billion MA overpayment estimate while AMGA urges CMS to revisit what it calls a historically low MA rate adjustment—raising stakes for provider groups dependent on MA shared-risk economics. At the same time, CMS is expanding model-based drug-cost policy as all states move into the Medicaid GENEROUS Model for most-favored-nation pricing, signaling that affordability and budget control are becoming central levers in Medicaid VBC and population-health strategy. Quality measurement risk is also intensifying, with Medicare bonus economics poised to shift based on data and scoring mechanics rather than clinical change, making documentation, analytics, and measure governance increasingly material to ACOs, MA plans, and delegated-risk providers.
Related Articles
Florida AG sues PBMs, pharmas over rise in insulin prices
Florida AG sues PBMs, pharmas over rise in insulin prices Fierce Healthcare
The Role of Comparator Selection in Ex-US HTA and International Drug Pricing
Pfizer, Lilly 'most favored nation' deals to give US share of raised foreign prices
The "most favored nation" drug pricing deals that Pfizer and Eli Lilly signed with the Trump administration suggest the companies will give the government a share of increased revenue they generate fr...
FAQ: How the GENEROUS Model Applies MFN Pricing to Medicaid
Do 340B Eligibility Rules Still Measure Hospital Need?
Congress should revisit how hospitals qualify for 340B drug discounts. H.R. 1’s Medicaid changes and court decisions affecting the Supplemental Security Income (SSI) fraction expose a weakness in the ...
US investigates German drug prices as EU pharmas seek to compete
American trade officials on Tuesday heard testimony for and against an investigation linked to Germany's declining payments for drugs, as EU-based pharma executives are pushing for more competitivenes...
STAT+: Did the Trump administration just cut Novo a huge financial win?
The White House's GENEROUS plan was designed to make drugs more affordable for Medicaid users. There's one glaring potential exception.
How Stakeholders Can Avert 340B Rebate Disruption
CMS says all states have applied for GENEROUS Model to provide most-favored-nation drug pricing
CMS says all states have applied for GENEROUS Model to provide most-favored-nation drug pricing American Hospital Association
Every state to join CMS Medicaid drug pricing model: 4 notes
Every state to join CMS Medicaid drug pricing model: 4 notes Becker's Payer Issues