AMCP 2025 Highlights – RamaOnHealthcare
TL/DR –
The Inflation Reduction Act could increase Medicare Part D restrictiveness, raise patient costs, and reduce innovation, meaning policy updates are needed for balanced cost containment and access. Federal policy changes, including PBM reform and evolving Medicaid/Medicare rules, are altering managed care pharmacy, requiring proactive advocacy and monitoring. There are over 500 state-level bills aimed at PBM reform, 340B oversight, and AI regulations, with significant federal changes like the Medicaid VBPs for Patients Act coming soon.
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AJMC
December 19, 2025
Major Insights
- The Inflation Reduction Act may lead to a rise in Medicare Part D restrictiveness, an increase in patient costs, and a decline in innovation, signaling the need for policy tweaks to balance cost containment and access.
- Alterations in Federal policy including PBM reforms and the evolution of Medicaid/Medicare rules are transforming managed care pharmacy, demanding vigilant advocacy and monitoring.
- Over 500 bills at the state level concentrate on PBM reform, 340B oversight, and AI regulations, with substantial federal changes like the Medicaid VBPs for Patients Act in the pipeline.
- Despite setbacks from patent thickets and settlement agreements, the 2025 pharmaceutical pipeline grows with generics, biosimilars, and innovative therapies.
- Demands for PBM transparency and reform underscore the need for collaboration among stakeholders to update practices, lower patient costs, and guarantee access.
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