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U.S. market access landscape: A push for control is erasing the boundary between payers and providers in U.S. healthcare

Clarivate

Oak Street has 169 locations across 21 states and expects to nearly double its size to 300 centers by 2026. CVS’ bid for Oak Street is in keeping with nearly two decades of evolution toward becoming an integrated payer and provider.

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Pharma’s pain from the Inflation Reduction Act will be felt well beyond the first 10 brands facing price cuts

Clarivate

Starting in 2026, the first ten self-administered Part D drugs in the law’s cross hairs will receive price cuts of 38%-79%. With the passage of the Inflation Reduction Act (IRA), the United States government gained the ability to directly negotiate drug prices with manufacturers.

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How retailers and “payviders” are disrupting U.S. healthcare in 2024

Clarivate

But, even without Amedisys, the insurer still has home healthcare company LHC Group, acquired in early 2023, and will leverage a long-term partnership with Walmart plus the nation’s largest network of employed and affiliated physicians through Optum to manage patient health and drive down costs for vulnerable patients.

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Making Sense of the Latest Changes to the Market Access Landscape

PM360

However, Medicare will only be able to negotiate prices for 10 Part D drugs in 2026, another 15 Part D drugs in 2027, another 15 Part D and Part B drugs in 2028, and another 20 Part D and Part B drugs for 2029 and subsequent years.

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Specialty Treatments Require a New Approach to Affordability

PM360

As a mission-driven company and digital healthcare leader, GoodRx has helped patients obtain an estimated 80 million prescriptions they otherwise may not have been able to afford. United States Specialty Pharmaceuticals Market & Forecast 2020-2026,” BusinessWire, December 8, 2020. IQVIA Institute, March 2022.