The CEA’s six hundred billion dollars drug savings projection is built on data the report’s own footnotes say don’t measure net prices. The policy is net-price-based. The data are gross-price-based.
Why did seventeen pharma CEOs sign voluntary MFN deals without anyone forcing them? One sentence in CMS guidance: GENEROUS supplemental rebates won’t affect Medicaid Best Price or three hundred forty billion ceilings.
Without that carve-out, every MFN rebate resets Best Price, cascading through three hundred forty billion across sixty six billion dollars in annual safety-net drug purchases. No CFO signs that deal. The carve-out IS the deal.
The BALANCE Model (two thousand twenty seven-two thousand thirty one) uses Section 1115A demo authority to put GLP-1s in Part D without repealing Congress’s two thousand three weight-loss drug exclusion. eighty percent opt-in threshold makes it effectively mandatory.
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