Pricing

The commercial PBM model is confronting structural strain as market forces—not regulation—begin to expose the fragility of high-rebate pricing economics.

CMS’s Globe and Guard models extend MFN pricing into Medicare Part B and Part D, signaling a sweeping shift in US drug pricing policy.

In today’s Pharma Pulse, the biopharma landscape enters a transformative phase as the US signs landmark PBM reforms into law, while Novartis braces for the largest patent expiration cycle in its history.

In today’s Pharma Pulse, HHS issues guidance for manufacturer-direct drug discounts, while clinical data warns of significant weight regain after stopping tirzepatide and semaglutide.

For the first time, CMS has released negotiated prices for high-cost drugs covered under both Medicare Part D and Part B, naming 15 new negotiation targets and signaling continued efforts to rein in prescription drug spending.

How direct-to-patient programming can transform the prescription journey for patients and manufacturers alike.

In today’s Pharma Pulse, the FDA and EMA synchronize on AI standards, a potential divide in pricing strategy occurs, and BoomRx launches a needle-free nanoemulsion for weight loss.

The company’s latest preview report projects a guarded rebound for biopharma, as investor confidence returns and M&A activity accelerates.

In today’s Pharma Pulse, Amazon Pharmacy launches Novo's first oral Wegovy pill with transparent cash pricing, Johnson & Johnson triples down on North Carolina manufacturing, and new clinical data links medical debt to rising eviction risks.

Novo Nordisk’s newly approved oral semaglutide is now available nationwide through Amazon Pharmacy with insurance and cash-pay options.

The pharma giant becomes the latest manufacturer to participate in the Trump Administration’s direct-to-patient pricing platform, aligning US drug costs with European benchmarks while reinforcing its domestic manufacturing investments.

In the second part of his Pharma Commerce video interview, Philip Sclafani, PwC’s pharmaceutical and life sciences lead, points out that a Medicaid spending tightens and ACA subsidies lapse, reduced public coverage is driving spillover effects—shifting costs to hospitals, employers, and commercial drug pricing in an increasingly interconnected healthcare market.

Nine more companies have joined the DTC government-run website, which is set to launch sometime next year.

Bill Roth, general manager and managing partner of IntegriChain’s consulting business, previews his new six-part series by outlining how rising payer fragmentation, divergent cash and insurance models, and supply-chain constraints are reshaping brand strategy.

In a discussion on emerging channel strategies, Bill Roth, general manager and managing partner of IntegriChain’s consulting business, explains why DTP models must extend beyond simple cash-pay offerings—highlighting how packaging innovation, insurance-flow backups, and improved patient compliance could unlock new revenue, streamline access, and better reflect clinical outcomes.

Traditional market access practices are being transformed by an increasingly rocky landscape of rebate, discount, and direct-distribution practices, but artificial intelligence may clear the pathways to profitability.

CoverMyMeds’ Megan Wetzel unpacks the forces behind rising specialty spend, the real impact of access barriers, and how field reimbursement teams help providers guide patients through today’s fragmented system.

How pharma can productively coexist with PBMs—and still lower drug costs faster.

A session explores how manufacturers can refine GTN strategy, strengthen pricing governance, and navigate increasingly complex distribution-channel economics, while maintaining both commercial performance and patient affordability.

In a wide-ranging keynote on disruption across pharmaceutical channels, Bill Roth, general manager and managing partner of IntegriChain’s consulting business, outlines why 2025 marks the beginning of a profound regulatory and commercial transformation—from sweeping policy shifts and accelerating WAC reductions to new debates on direct-to-patient strategies and looming instability in medical benefit reimbursement.

The fracturing of the US drug market’s traditional model is forcing a demand for a strategic bifurcation to maintain profitability, compliance, and patient access in the decade ahead.

Various agreements with the Trump administration could have long-term ramifications for Medicaid access and global pricing strategy.

Commercialization expert Bill Roth outlines the critical need for "adaptive capacity," detailing how accelerating government regulation and massive patent cliffs are forcing a complete overhaul of commercial strategies across various markets.

The entrepreneur urges the Trump administration to eliminate costly FDA generic drug fees, part of a broader push to scale domestic production, address shortages, and challenge PBM-driven pricing models.

In the final part of his Pharma Commerce video interview, Ed Schoonveld, value and access advisor for Schoonveld Advisory and author of The Price of Global Health, previews his December column, exploring US price-referencing guidance, its impact on innovation, and whether this marks the beginning of broader pricing controls.