Category

Market Access & Reimbursement

Market access and reimbursement decide whether an authorised product reaches patients and how it is paid for. Health Technology Assessment bodies evaluate clinical and economic value, the EU HTA Regulation now provides joint clinical assessments for certain medicines and high-risk devices, and pricing and coverage decisions still vary widely by country.

Regulation Category Type · Breadth Date

Medicare and Medicaid Programs; Interoperability Standards and Prior Authorization for Drugs for Medicare Advantage, Medicaid, CHIP, and Qualified Health Plans

Proposed requirements for electronic prior authorization for drugs and extended interoperability standards across Medicare Advantage, Medicaid, CHIP, and QHP issuers.

US Federal Register - CMS Rules · United States
Health Data, Privacy & SecurityMarket Access & ReimbursementHealth System & Payment InteroperabilityHealth dataEHDS
Consultation Framework

Drug and Device Manufacturer Communications With Payors, Formulary Committees, and Similar Entities—Questions and Answers; Revised Draft Guidance for Industry

Revised draft guidance on manufacturer communications of health care economic information about approved drugs and devices to payors and formulary committees.

US Federal Register - FDA Guidance Notices · United States
Market Access & ReimbursementPharmaceuticalsMedical Devices & IVD ReimbursementMarket surveillance
Guidance Framework

CY 2027 Medicare Payment Policies: Physician Fee Schedule, Part B Payment, Shared Savings Program, and Prescription Drug Inflation Rebate Program

CMS proposes updates to physician fee schedule, Part B payment policies, Medicare Shared Savings Program, Quality Payment Program, and Promoting Interoperability Program for calendar year 2027.

US Federal Register - CMS Rules · United States
Health System & PaymentMarket Access & Reimbursement Provider paymentReimbursementInteroperability
Rule change Framework

Calendar Year 2027 Home Health Prospective Payment System (HH PPS) Rate Update; Requirements for the HH Quality Reporting Program and the Expanded HH Value-Based Purchasing Model; Medicare Provider Enrollment, Durable Medical Equipment (DME), and DMEPOS Policies

CMS proposes updates to Medicare home health payment rates, case-mix weights, quality reporting requirements, and DME enrollment and benefit policies for calendar year 2027.

US Federal Register - CMS Rules · United States
Health System & PaymentMarket Access & Reimbursement Provider paymentReimbursement
Rule change Framework

Pricing of new pharmaceutical products, Q2 2026: new products, reference product repricing following data protection expiry, and price adjustment requests for non-reimbursed formulations

Greece's EOF pricing department proposes pricing decisions for new medicines, repricing of reference products, and examination of price adjustment requests for non-reimbursed formulations in Q2 2026.

Greece EOF · Greece
PharmaceuticalsMarket Access & Reimbursement PricingReimbursement
Consultation Framework

Medicare Program; Contract Year 2027 and Certain Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program

Final rule revises Medicare Advantage, Prescription Drug Benefit, and cost plan regulations for Star Ratings, marketing, drug coverage, and enrollment.

US Federal Register - CMS Rules · United States
Health System & PaymentMarket Access & Reimbursement ReimbursementProvider payment
Rule change Framework

Patient Protection and Affordable Care Act: HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program

Final rule sets 2027 payment parameters, user fee rates for health plan issuers, risk adjustment provisions, and QHP certification standards including provider access and essential health benefit requirements.

US Federal Register - CMS Rules · United States
Health System & PaymentMarket Access & Reimbursement Provider paymentReimbursementProcurement
Rule change Framework
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