Government Payers

Medicaid Changes Could Have Major Impact on Recent Coverage Improvements

 
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Insurance trade groups warned that the Big Beautiful Bill destabilize Medicaid and result in the largest ever roll-back in health care coverage in the US.

England’s NHS Plan Eyes Cancer Vaccine Boost, Single Formulary & ‘Pay For Impact’ Drug Deal

 

The creation of a single national formulary for medicines prescribing that could impact industry is among the action points in the UK government’s new 10-year health plan for the National Health Service in England.

US Budget Bill Eases IRA Price Controls But Coverage Losses Will Impact Pharma

 
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The legislation expected to be signed by President Trump is a mixed bag for pharmaceutical manufacturers depending on their product mix and manufacturing situation.

Kennedy Appears Ill-Informed On Major Pharma Priorities, Creating Unique Lobbying Dynamics

 

The Health and Human Services Secretary made incorrect statements about the status of key industry priorities at a recent House hearing, which actually may be a good thing for drug sponsors.


How Could MFN Pricing Impact Commercial Market?

 
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Industry experts forecast the impact of President Trump's Most-Favored Nation drug pricing policy on the commercial insurance industry.

Medicare’s Combo Products Negotiation Plan Conflicts With US FDA Standards, Firms Argue

 
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The plan could curtail a period of pricing flexibility for newer subcutaneous versions of important oncology drugs.

Trump Administration Closer to Unprecedented Drug Price Transparency Requirements

 
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New rules requiring more granular drug pricing data to be disclosed in machine-readable files will go into effect in 2026.

Orphan Drug Relief Still In Budget Bill But Uncertainty Remains

 
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The budget reconciliation bill nears final passage without pharmacy benefit manager reforms or provisions that would facilitate access to cell and gene therapies for children, but its Medicaid cuts pose a significant threat to prescription drug access.


Oz Says Big PBMs Have ‘Window’ to Quit Rebate System on Their Own

 
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CMS Administrator Mehmet Oz said PBMs may deserve "one last chance" to fix the rebate system before federal regulations and legislation are enacted.

Canada Unveils Draft List of Essential Drugs For Universal Pharmacare

 

The list of essential prescription drugs and related products will shape Canada’s first national formulary for the country’s universal pharmacare program.

Repurposed Drugs: EU Pharma Reform Offers Boost, But Payers ‘Must Recognize Health Gains’

 

Incentives for repurposed drugs proposed as part of the EU pharma reform package are a “great step forward,” but more recognition is needed from payers and regulators to leverage the benefits of these medicines, experts say.

New Drug Procurement Rules Aim To Drive Pharma Investment In Mexico

 

Legal experts warn, however, that new Mexican procurement rules are discriminatory and could be challenged in the courts.


Price Inflation Rebates: Biden Policies Add Teeth To Trump’s Pharma Tariff Threat

 
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Companies with significant exposure to Medicare and Medicaid have fewer options for passing along higher costs to consumers because of price controls in the programs.

Welireg Among Japan Recommendations; Economic Policy Raises Hopes Of Higher Prices

 
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Country recommends eights new drugs for approval, including six for rare diseases, and also announces macroeconomic policy the pharma industry says would enable some reimbursement prices to be raised.

HTA Expert Warns Of Escalating Measures If Pharma Fails To Tame Prices

 

Too many “uninformative” drug trials fail to justify the excessively high prices of many medicines, while there is too much evidentiary uncertainty in European pricing and reimbursement systems, warned Anja Schiel from Norway’s NOMA.

Pink Sheet Podcast: The US and Ex-US Impact Of Most-Favored Nation Drug Pricing

Pink Sheet reporter and editors discuss the potential impact of the Most-Favored Nation drug pricing proposal on Europe, the United States, as well as the pharmaceutical industry.


PCMA, CVS, Cigna File Lawsuits Over ‘Dangerous’ Arkansas PBM Law

 
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The suits are an early test of the Arkansas law banning company ownership of PBMs and pharmacies in the state, as other states consider similar legislation.

Medicare Part D LIS Access Threatened By House Budget Bill’s Medicaid Obstacles

 
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An unintended consequence of a provision framed as an administrative change in the bill could significantly reduce medication adherence among low-income older adults and increase mortality, a study found.

Pharma’s Protests Fall Flat As UK Locks In High Rebate Rates

 

Despite pushback by industry, the government is standing by its new statutory scheme rebate rates for branded medicines, including one that doubles the rate that companies must repay on the sales of newer products to the National Health Service to 31.3%.

Crisis Or Opportunity? US MFN Policy Could Test Japan’s Appetite For Reforms

 
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While the adoption of most favored nation drug pricing in the US stands to affect Japanese biopharma firms now heavily reliant on this market, it might also present an opportunity for pricing and policy reforms at home.