Episode 115 – Drug Pricing and Market Access: Highlights From Recent CMS and AHLA Conferences

In this episode of Connected with Latham, Chris Schott, Danny Machado, and Evan Rothkoff discuss key takeaways from two major healthcare conferences: the American Health Law Association's Institute on Medicare and Medicaid Payment Issues and the CMS Quality Conference. The conversation centers on the latest developments in drug pricing and market access, including the implementation of the Inflation Reduction Act, the evolving Most Favored Nation (MFN) pricing policy under Globe and Guard, and the ongoing debate around 340B drug pricing reform. The panel highlights CMS's growing role in shaping policy, with government officials emphasizing fraud prevention, data tracking challenges, and the expansion of payment models through the Center for Medicare and Medicaid Innovation (CMMI). A major focus is on GLP-1 drugs and the upcoming voluntary balance program that will cap out-of-pocket costs at $50 per month for certain Part D beneficiaries starting in 2027, with a short-term bridge model launching in July. The episode underscores the increasing complexity and pace of regulatory change, requiring pharmaceutical manufacturers to adopt coordinated, multidisciplinary strategies to navigate compliance and innovation incentives. The hosts conclude with a lighthearted discussion comparing the drug pricing landscape to Olympic sports—baseball/softball for CMS’s team-based structure, hockey for its intensity, and the 4x400 relay for the need for seamless collaboration across departments. Key takeaways include: (1) The U.S. drug pricing landscape is rapidly evolving with multiple overlapping initiatives like Globe and Guard, MFN pricing, and 340B reform, requiring manufacturers to stay agile; (2) CMS is investing heavily in infrastructure and staffing—CMMI plans to double its drug-focused team—to implement and monitor new payment models; (3) The upcoming $50/month cap on GLP-1 costs via the BRIDGE program signals a shift toward patient affordability, but manufacturers must prepare for mandatory participation in future MFN-based models; (4) Industry conferences are critical for real-time intelligence on government priorities and stakeholder sentiment; (5) Success in this environment demands cross-functional collaboration, with legal, compliance, and commercial teams working in sync. The episode ends on a positive note, emphasizing that while the regulatory environment is complex, it also presents opportunities for strategic innovation and market leadership.