Market Access

From billions in drug savings and more, we present to you today’s Pharma Pulse.

The Trump administration has announced new negotiated Medicare prices for a second wave of blockbuster treatments, yielding an estimated $12 billion in savings for 2027, when compared to Medicare’s 2024 net spending.

In today’s Pharma Pulse, the federal government prepares to unveil newly negotiated Medicare prices for 15 high-cost drugs, while Novartis receives FDA approval for Itvisma, a one-time gene therapy offering a new treatment pathway for older children and adults with spinal muscular atrophy.

As the federal government prepares to release newly negotiated Medicare drug prices, weight-loss blockbusters Ozempic and Wegovy remain in the spotlight, while CMS advances a model to cut Medicaid spending and broaden access to affordable treatments.

When intelligence flows across clinical, access, and engagement channels, commercialization shifts from reactive to predictive, giving teams the real-time edge to win in a fast-moving market.

In today’s Pharma Pulse, learn how digital pharmacy safety gaps, Novo Nordisk’s introductory programs for Wegovy and Ozempic, and Scott Gottlieb’s new role at UnitedHealth are shaping patient access and industry strategy.

The company is launching new self-pay pricing options, expanded savings programs, and partnerships with telehealth and retail providers. all while its obesity portfolio gains momentum under the FDA’s National Priority Voucher program.

The nationally licensed pharmacy network now supports Ethereum, Solana, and XRP across all retail locations, marking a major step toward faster, more transparent payments—and laying the groundwork for a blockchain-based prescription drug payment system.

As FDA fast-tracks GLP-1 treatments under its new pilot National Priority Voucher program, WeightWatchers prepares to position itself to compete in the fast-evolving weight-loss drug market driven by affordability and accessibility.

Launching next year, the new CMS Innovation Center initiative—known as the GENEROUS Model—aims to align Medicaid drug prices with global standards, reduce prescription spending, and strengthen the program’s long-term sustainability through fairer state purchasing and transparent pricing rules.

Lilly announced a new agreement with the Trump administration to expand access to its GLP-1 therapies, including Zepbound and orforglipron, offering the drugs to Medicare beneficiaries for $50 per month and through Medicaid programs starting in 2026.

Pharma’s push into direct-to-patient sales is reshaping the front end of drug distribution, but wholesalers like Cencora, McKesson, and Cardinal Health remain indispensable as the backbone of the industry’s regulated, specialty, and logistics infrastructure.

As the three models converge, expect a bigger role for sales reps, minimal impact on incentive compensation, and a boon to the healthcare system.

At HLTH 2025, the entrepreneur announced a collaboration between Cost Plus Drugs and President Trump’s TrumpRx platform aimed at improving transparency, reducing drug costs, and reshaping how Americans access their prescriptions.

Aetna, Devoted Health, and UnitedHealth headline the list best Medicare Advantage insurers for next year, while Centene and Humana lead the pack in Part D prescription drug coverage.

A planned 100% tariff on branded and patented drugs from Singapore is being postponed as US and Singapore officials explore potential exemptions.

The appellate court upheld Medicare’s authority to negotiate lower drug prices under the Inflation Reduction Act, following similar rulings against AstraZeneca, Bristol Myers Squibb, and Novartis.

Amid intensified competition—and evolving IRA and PBM dynamics—leaders in the access space must now adopt a strategist mindset.

Marketed as cost-saving tools, AFPs can also strain safety-net resources.

From patent cliffs and government price controls, to self-pay models and staff-model HMOs, a look at the forces that could deflate the bubble—and those factors likely to keep it afloat a while longer.

Amid pressures on pharma to match the lowest international prices, experts warn of “policy laundering” and discriminatory impact.

Capturing insights from executives and industry experts on the biggest challenges shaping pharma today, from drug pricing pressures and access barriers to supply chain shifts, digital adoption, and evolving patient-centered care strategies.

This episode of Pharma Pulse covers new research showing Medicaid cuts could widen pediatric coverage gaps, clinical trial data on a fixed-dose combination therapy lowering heart failure risk in type 2 diabetes, and Bristol Myers Squibb’s launch of a direct-to-patient program for Sotyktu to improve psoriasis treatment access.

This episode of Pharma Pulse covers the CDC’s unanimous vote to broaden COVID-19 vaccine recommendations for all adults, new data showing the Medicare Part D Senior Savings Model lowers insulin costs and improves care, and Eli Lilly’s investment in a new Houston manufacturing facility to support its fast-growing pipeline.

The draft assessment finds that the popular weight loss drugs are costly but worth the price tag, while also urging for broader coverage and policy solutions.