Pharma finance and access leaders highlighted mounting complexity at the 340B and Medicaid intersection, pointing to reconciliation risk that can produce prohibited “double-dipping” scenarios. Panelists underscored the need for cross-functional alignment between finance, pricing, commercial teams, and access groups to avoid paying both a 340B discount and a Medicaid rebate for the same covered patient. The discussion also addressed volatility in Medicaid forecasting for generics, including unit rebate amount uncertainty versus patient utilization. Speakers emphasized that brands must be tracked across lifecycle phases to understand payer mix changes that can destabilize gross-to-net planning. Regulatory and enforcement scrutiny of government pricing and contracting practices is expected to remain a live operational issue as manufacturers continue to modernize GTN accounting, payer controls, and audit-ready documentation.