Drug Pricing

CMS finalized a permanent framework for Medicare drug price negotiations, including selection of up to 20 additional Part D and/or Part B drugs by February 1, 2027, for prices effective in 2029. The rule creates compliance and planning implications for manufacturers, Medicare plans, and firms supporting drug pricing, formularies, benefits administration, and payment operations; it does not announce a procurement opportunity.

The Centers for Medicare & Medicaid Services (CMS) has begun its GENEROUS Model aimed at aligning Medicaid drug prices with international standards. This initiative, involving all 50 states, is projected to save $64.3 billion over ten years and necessitates updates in contracting within the healthcare sector.

A new bipartisan Patients Before Monopolies (PBM) Act seeks to ban PBM ownership of pharmacies. This legislation increases regulatory scrutiny and compliance burdens for healthcare contractors, potentially reshaping procurement strategies across the pharmaceutical sector.