In Parts 1 and 2 of "The Great Repricing," we examined how the U.S. pharmaceutical market has split into three distinct payer economies, commercial, government and self-pay, and the mounting pressure reshaping the commercial channel and PBM model. This installment focuses on the biggest driver of all: government.

Government isn't a secondary payer following commercial market trends anymore, it's setting the terms. HHS and CMS now function as price-setters, with reimbursement ceilings, compliance rules and pricing frameworks that ripple across the entire pharma ecosystem.

This isn't a policy stance. It's simple math: government is now driving the market, not trailing it.