The Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) recently announced the creation of a new Healthcare Advisory Committee—a body tasked with improving how care is financed and delivered under federal insurance programs.
On the surface, the committee’s mandate sounds familiar: streamline red tape, modernize Medicare Advantage, strengthen Medicaid quality, and improve chronic disease management. But for manufacturers, the formation of this committee signals something more important: a new era of uncertainty in how federal payers set the rules.
Why This Matters for Market Access
The committee will be advising on issues with direct implications for drug pricing, contracting, and evidence requirements.
- Medicare Advantage: Expect pressure on risk adjustment and quality measures that can directly influence access and rebate strategies.
- Medicaid: The focus on improving quality “outside of more funding” could lead to new utilization management levers or access restrictions.
- Administrative Burden: If CMS reduces quality reporting requirements, the metrics manufacturers rely on to demonstrate value may change.
In short, the rules of engagement between manufacturers, payers, and providers may be redefined—and quickly.
The Risk of Waiting
We’ve seen this before. Policy shifts under the Inflation Reduction Act and the Most-Favored-Nation Executive Order rewrote decades of pricing playbooks nearly overnight. Teams that relied on static advisory boards and once-a-year payer feedback found themselves caught off guard.
With a federal advisory committee now tasked with redesigning elements of Medicare and Medicaid, the lesson is clear: market access strategy cannot wait for policy to crystallize.
How to Prepare
High-performing manufacturers are moving from “watch and react” to real-time, iterative planning. At eMAX Health, we built MAVA™ for exactly this reason:
- Payer Panels on Demand: Test assumptions with U.S. and global payers in just five business days.
- Elasticity™ Modeling: Simulate pricing scenarios as new reimbursement structures emerge.
- Contracting ROI: Quantify rebate tradeoffs in the context of evolving risk adjustment and Medicaid quality requirements.
When advisory committees start changing the rules, teams need more than speculation. They need data, payer input, and validated scenarios—fast.
Looking Ahead
The Healthcare Advisory Committee’s recommendations may not be final policy, but they will set the tone for how CMS evaluates sustainability, quality, and value in the years ahead. Manufacturers who invest in agile insight engines now will be best positioned to adapt without losing ground.
Questions to consider today:
- What assumptions in your current access strategy are most vulnerable to new CMS measures?
- How are you validating payer sentiment around potential changes in Medicare Advantage or Medicaid?
- Do you have the infrastructure to test and adapt in days—not months—if the policy environment shifts?
At eMAX Health, we help market access teams anticipate—not just respond to—federal payer priorities. The time to pressure-test your strategy is before the new committee makes its mark. Contact us to get started. info@emaxhealth.net