Value-Based Pricing for CMS Drug Price Negotiation: Mission Impossible?
Moderator
Peter Neumann, ScD, Tufts Medical Center, Boston, MA, United States
Speakers
Feng Xie, PhD, McMaster University, Hamilton, ON, ON, Canada; Sean D Sullivan, PhD, University of Washington, Seattle, WA, United States; Joshua Cohen, PhD, Tufts Medical Center, Boston, MA, United States
Issue/Overview:
The CMS Medicare Drug Price Negotiation Program has now completed two negotiation cycles. Although the statute directs CMS to consider comparative clinical effectiveness, unmet clinical need, R&D and production costs, and other factors, the translation of these considerations into final negotiated prices remains opaque. With recent methodological work by Li et al. (2025) Xie et al. (2025), both in Value in Health, and Neumann et al. (2025) in Health Affairs Forefront, there is an interest in whether value-based pricing could serve as a transparent and analytically rigorous foundation for CMS.
This issue panel will explore how negotiated prices might differ under value-based versus non–value-based approaches and examine the opportunities and challenges of integrating value assessment into CMS pricing decisions.
The panel will discuss the practical, methodological, and policy implications of using value-based pricing to inform CMS negotiations, including transparency, feasibility, data requirements, stakeholder acceptance, and potential impacts on innovation and access.
Topic
Health Policy & Regulatory