Podcast — Drug Pricing: How Are Payers Responding to the IRA?
Podcast: IP(DC): Drug Prices, Political Pressures & Patents
Both the House and Senate have been in recess for the last two weeks. While lawmakers have been out of town, focus has remained on funding the US Department of Homeland Security....more
The Centers for Medicare & Medicaid Services (CMS) has issued its Advance Notice and related rulemaking for the Medicare Advantage (MA) and Part D programs for plan year 2027. ...more
The Centers for Medicare & Medicaid Services (CMS) has finalized the calendar year (CY) 2027 Medicare Advantage (MA) and Part D rule, with policies effective June 1, 2026, and applicable to coverage beginning January 1, 2027....more
Our Drug Pricing and Market Access team tracks recent developments in healthcare reform, the Medicaid Drug Rebate Program, the 340B Program, Medicare, and state law....more
The Pharmacy Benefit Management (PBM) Working Group is moving toward a more robust, standardized PBM examination and oversight framework—expanding focus to affiliated entities (like GPOs), pricing/rebate pass-through, network...more
On March 31, the Centers for Medicare & Medicaid Services (CMS) Innovation Center released the much anticipated Request for Applications (RFA) for the Long‑term Enhanced Accountable Care Organization Design (LEAD) Model, a...more
2025 was a busy year for federal health law, with several major laws, regulations, and policy changes. Many of these will still be relevant in 2026. The following is a brief overview of the most significant developments and...more
Federal policymakers are moving aggressively on prescription drug pricing in 2026, with activity spanning IRA implementation, new CMS Innovation Center models, and direct action from the Trump administration....more
Senate Aging Committee holds hearing on drug supply chain. Republicans and Democrats expressed interest in policy proposals to promote domestic drug production....more
The Inflation Reduction Act (IRA) has reshaped how Medicare covers and reimburses prescription drugs. For the first time, the federal government established prices for ten drugs selected through the Medicare Drug Price...more
On January 26, 2026, CMS released the Advance Notice of Methodological Changes for Calendar Year (“CY”) 2027 for Medicare Advantage (“MA”) Capitation Rate and Part C and Part D Payment Policies (the “Advance Notice”). In the...more
As you know, I like food analogies. If Medicare Advantage (MA) and Part D policymaking was a multi-course meal (such as brunch with eggs!), we just finished a major course for plan year 2027....more
PBM reform is taking an even deeper turn, as shifts in the obligations imposed on pharmacy benefit managers (PBMs) are taking place at the federal level, directly impacting PBM prescription drug pricing transparency and...more
This issue of McDermott Will & Schulte’s Healthcare Regulatory Check-Up highlights regulatory activity for January 2026. The US Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued two...more
The Centers for Medicare & Medicaid Services ("CMS") unveiled the Long-term Enhanced Accountable Care Organization ("ACO") Design ("LEAD") model, which aims to expand provider participation, increase beneficiary involvement...more
There have been a series of court cases and federal legislation targeting the spread pricing model often used by pharmacy benefit managers (PBM). Spread pricing involves two points of time in prescription drug transactions....more
On January 27, 2026, the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) issued a special advisory bulletin applying the federal Anti-Kickback Statute to a pharmaceutical manufacturer’s offer...more
As 2025 drew to a close, the Centers for Medicare & Medicaid Services (“CMS”) issued proposed rules for two mandatory pricing models aiming to reduce out-of-pocket costs for Medicare drugs....more
On January 26, 2026, CMS released its Advance Notice of Methodological Changes for Calendar Year (CY) 2027 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (Advance Notice). The Advance...more
On February 3, 2026, Congress passed – and the President signed – the Consolidated Appropriations Act, 2026 (2026 CAA). The legislation includes a long‑anticipated and far‑reaching package of PBM reforms. These reforms draw...more
Pursuant to the Inflation Reduction Act (the “IRA”), the Secretary of Health and Human Services (“HHS”) and the Center for Medicare & Medicaid Services (“CMS”) have begun the annual process of negotiating with pharmaceutical...more
On February 3, 2026, a comprehensive fiscal year (FY) 2026 appropriations package advanced through the US House of Representatives, finishing the legislative process for five of the six remaining appropriations bills....more
The Inflation Reduction Act (IRA), signed into law on August 16, 2022, allows the federal government to negotiate prices for some high-cost drugs covered under Medicare. ...more
On January 26, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year 2027 Advance Notice of Methodological Changes for Medicare Advantage (MA) capitation rates and Medicare Part D payment policies. CMS...more
Often in the policy realm (and especially in the health space), major reforms are tackled in both the legislative and regulatory arenas. Congress may enact standalone policies that regulators are required to implement, or...more