DRUG COSTS

Out of control—or delivering value?

Pharma innovation isn’t free—but few believe the sick should bear the costs. Balancing costs and benefits requires data, collaboration, and the courage to try new things.

Efficacy within reach

Is affordability a pipe dream?

As drugs become more sophisticated and targeted, they often become dramatically more expensive. Even common drugs can see massive price increases when patents change hands or new uses are found.

As our healthcare systems and patients bear the cost of pharmaceuticals, how do we create a system that is fair to all—especially those whose lives could be saved by greater availability of medications?

landmark legislation

Healthcare changes in the Inflation Reduction Act

From negotiated drug prices to Medicare Part D redesign, our research and analysis break down the law’s implications for plan sponsors, health plans, and pharmaceutical manufacturers.

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article

Complexities in forecasting eligible cases and associated costs of cell and gene therapy

Beyond epidemiology, clinical trial criteria, and the science

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article

A primer on prescription drug rebates

Insights into why rebates are a target for reducing prices

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Infographic

Payer strategies for weight-loss medications

Demand is up for drugs like Wegovy and Ozempic. How can plans balance the potential health benefits with adherence challenges and waste?

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Related insight

Report

The impact of medication adherence on total healthcare costs for commercially insured patients

A current perspective for patients with diabetes, hypertension, and hyperlipidemia

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White paper

Emerging Medicare Advantage and Part D trends from 2024 financial statements

Medicare Advantage (MA) and Part D insurers are citing significant financial headwinds in earnings calls and the press. Statutory financial statements provide insights into emerging trends through year-end 2024.

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White paper

Medicare price negotiation: Anchored drug prices in uncharted waters

Maximum Fair Price (MFP) Issue Brief 2

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Preheading

How will Medicaid Pay for Cell and Gene Therapies

Amid the development of new cell and gene therapies, we present some strategies that states have used to control costs and risk among their MCOs.

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White paper

The evolution of biosimilars in the United States

Biosimilars recently have made significant strides toward greater acceptance and utilization since their first U.S. approval in 2015, although challenges persist.

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White paper

Commercial drug trends: 2024 release

This report provides insights into pharmacy cost and utilization trends based on our analysis of the Milliman Consolidated Health Cost Guidelines Sources Database.

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Article

Controlling Rx costs: Top 5 reasons for a PBM RFP

Five reasons why RFPs with PBMs should be a regular practice to help control Rx costs.

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Article

Impact of the Inflation Reduction Act on plans seeking creditable coverage

The Inflation Reduction Act’s higher standards for retiree prescription drug plans may require plan sponsors to enrich benefits in 2025 for creditable coverage.

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White paper

Average Manufacturer Price cap removal: Implications for state Medicaid programs

As a new federal law, effective in 2024, removes a cap on manufacturers' drug rebate amounts, we explore the implications for state Medicaid programs.

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WHITE PAPER

Payer strategies for GLP-1 medications for weight loss

We examine various strategies related to GLP-1 medications such as Wegovy when used for weight loss to help payers understand the landscape, develop a coverage strategy, and minimize waste.

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