Radar on Drug Benefits

Payers Eye Rebate Leverage, UM in Response to Medicare-Negotiated Drug Prices

  • Aug 22

    Aug 22, 2024

    Now that CMS has revealed the prices of the first 10 drugs subject to Medicare price negotiation, all eyes are on how Part D plans will cover those drugs on their formularies in 2026, when the new prices go into effect.  

    To that end, a recent poll from Zitter Insights offers some clues about how payers and PBMs are thinking about this thorny question. 

    The flash poll was conducted after CMS revealed the results of the first round of the Medicare Drug Price Negotiation Program, which was authorized by the Inflation Reduction Act. Through that process, Medicare for the first time set a Maximum Fair Price (MFP) for 10 branded drugs selected due to their high cost and lack of generic or biosimilar competition.  

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    • Leslie Small

    Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.

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Meet Our Reporters

Lauren Flynn Kelly

Executive Editor, AIS Health, and Managing Editor, Radar on Medicare Advantage

View Lauren Flynn Kelly's Profile

Angela Maas

Managing Editor, Radar on Specialty Pharmacy and Spotlight on Market Access

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Leslie Small

Managing Editor, Health Plan Weekly and Radar on Drug Benefits

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Carina Belles

Reporter, Radar on Medicare Advantage and Spotlight on Market Access

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Jinghong Chen

Reporter, Health Plan Weekly and Radar on Drug Benefits

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Jill Drachenberg

Reporter, Health Plan Weekly and Radar on Drug Benefits

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Drug Pricing
Medicare Part D
Benefit Management
Drug Rebates
Medicare Advantage Rx Drug
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