Lower GLP-1 Pricing Is Finally Here—What Employers Need to Know
Rising GLP-1 medication costs have become one of the most urgent challenges for self-funded employers. Demand continues to grow, outcomes remain strong, and employees want access—yet many organizations simply can’t justify the high and unpredictable pharmacy spend tied to drugs like Wegovy® and Ozempic®.
Cracking Open the PBM Black Box: Why Transparency Is the Next Frontier in Pharmacy Benefits
In an era where data drives every decision, pharmacy benefits management (PBM) remains one of the most opaque sectors in healthcare. For decades, employers, consultants, and health plans have operated in the dark—unable to see what truly drives drug costs. The result? Hidden markups, misaligned incentives, and missed opportunities for savings. That’s changing fast. The […]
Medical Benefit vs. a Pharmacy Benefit: What’s the Difference
The main difference between medical and pharmacy benefits lies in how care is delivered and billed. Medical benefits typically cover treatments and medications provided by a healthcare professional in a clinical setting, such as infusions or surgeries. Pharmacy benefits, on the other hand, cover prescription drugs that are usually filled at a pharmacy and taken […]
PBM Contract Requirements: How to Negotiate Favorable Terms
PBM contracts shape critical decisions that impact healthcare costs, compliance, and patient outcomes. Securing the right terms can dramatically improve pharmacy plan performance and member care. Here’s what you need to know about PBM contract requirements, how to negotiate better terms, and how to avoid common pitfalls.. Additionally, we explore future trends in PBM contracting, […]
The Power of Real-Time Data in the PBM Industry: Why It Matters and How to Use It
Real-time data analytics helps organizations react in real time to market or client behavior changes. It enables companies to identify and address problems before they become significant. But what is real-time data, and how can it be deployed in the pharmacy benefit management (PBM) space? What is Real-Time Data (RTD)? Real-time data is the capture […]
How to Streamline Rebate Administration
Managing drug rebates effectively is critical for employers, consultants, PBMs, and health plans seeking to control pharmacy benefit costs while ensuring quality care for their members. However, traditional rebate management can be complex, time-consuming, and prone to errors when handled manually. By leveraging automation and real-time data, it’s possible to simplify the entire rebate process, […]
PBM Rebates Explained: How They Work and What to Know
Pharmacy Benefit Managers (PBMs) are critical in controlling prescription drug costs, and rebates are a big part of that process. While they are complex, rebates can save employers, health plans, and even patients significant money when used effectively. In this post, we unpack PBM rebates, explain how they work, who benefits from them, and why […]
Navigating Drug Shortages: A Growing Challenge for the Healthcare System
Imagine walking into a pharmacy or hospital only to hear, “We don’t have that medication right now.” For many patients and healthcare providers, this frustrating scenario is becoming all too common. Drug shortages – whether it’s a life-saving treatment or an everyday antibiotic – are an ongoing challenge for the U.S. healthcare system. These shortages […]
How Technology is Revolutionizing the PBM Business
Pharmacy Benefit Managers (PBMs) are at the heart of modern healthcare, coordinating relationships between insurers, pharmacies, and manufacturers to streamline prescription drug access and control costs. For decades, the PBM industry has grappled with inefficiencies, rising drug prices, and increasing scrutiny from regulators and the public. However, modern technology has become a game-changer, transforming PBM […]
Top 4 PBM Trends to Watch in 2025 and Beyond
As the pharmacy benefit management (PBM) industry continues to evolve, a handful of key PBM trends are reshaping the landscape for employers, healthcare providers, and patients alike. Driven by a push for transparency, the demand for more affordable, effective treatments, and innovative therapeutic options, PBMs are experiencing unprecedented challenges and opportunities. Four major trends stand […]
