Part I: What the Six Hundred Billion Dollar MFN Headline Misses: The Best Price Carveout, the IQVIA Net Price Hole, and the CMMI BALANCE Workaround That Makes Trump’s Drug Pricing Framework Run

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.Subscribe to www.onhealthcare.tech for free and paid articles, podcasts, and more. For a further deep dive on the topic from today’s podcast, see the newsletter link. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.onhealthcare.tech/subscribe