PBM Transparency Is Still Too Opaque — How Can Employers Rein In Drug Costs?
Employers are trying to comparison shop in a market where all the price tags are hidden. And most can’t simply switch PBMs to find better pricing for their members.
Report: High Drug Costs Are Creating Hidden Burden for Physicians
When drug prices are too high for patients, physicians take on additional workload to find solutions. A newly released 2026 Physician Drug Cost Survey by RazorMetrics examined how prescription cost pressures affect physicians’ practices.
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The Healthcare Payments Industry Faces a Perception Challenge
Healthcare payments are no longer about transactions. It’s about controlling the revenue cycle. And increasingly, that control is not sitting with ISOs.
The True Cost of Focusing on Cost Instead of Cost-Effectiveness
When payors consider only the cost of the medication and not the cost and risk to the patient, doctor, and healthcare system, the irony is that not only is this terrible for patient health, it can be more costly in the end.
HHS Is Reviving Its 340B Rebate Push — And Providers Are None Too Pleased
HHS is reviving a rebate program for 340B drug discounts after the previous pilot was blocked in court earlier this year. Providers say the change will burden already cash-strapped providers with new administrative and financial costs.
Mark Cuban: Employers Are Unknowingly Profiting From Sick Workers’ Drug Costs
Mark Cuban warned that many employers are collecting drug rebate money funded by their sick employees — a practice that can violate fiduciary duties under ERISA. His company, Cost Plus Drugs, is partnering with organizations like Humana’s CenterWell to create direct-to-employer programs that bypass PBMs and deliver medications at lower net prices.
Blue Shield of California Launches New Digital Tool for Medication Transparency
Through a new tool, Blue Shield of California members can now be notified when a clinician begins an e-prescription and view lower-cost alternatives.
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Closing the Quality-Affordability Gap in Workplace Mental Health
In an interview, Kyan Health Co-Founder and Chief Commercial Officer Konstantin Struck discussed how Kyan gives mid-market and enterprise employers access to premium workforce mental healthcare, at a price point that is affordable.
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How AI, Analytics, and Collaboration Can Solve Specialty Drug Spending Challenges
Nicole Bulochnik, Abarca Senior Vice President of Drug Value Strategy, explained how AI, analytics, and cross-sector collaboration can transform specialty drug costs.
Trump’s Executive Order on Prescription Drug Costs Delivers a Win for Pharma Companies
The Trump administration aims to change the Medicare Drug Price Negotiation Program in a way that would delay when certain drugs can be selected for negotiation.
The Big 3 PBMs are Countersuing the FTC. Does Their Argument Have Any Teeth?
After the FTC filed a lawsuit in September, accusing the three major pharmacy benefit managers of anticompetitive rebating practices related to insulin, the defendants reversed roles and became plaintiffs. In November, they countersued the agency, arguing that its lawsuit is unconstitutional.
Managing the Specialty Drug Cost Challenge: Is Your Pharmacy Benefits Strategy Ready for 2025?
What concrete strategies should employers pursue to control rising costs while ensuring the best member experience and clinical outcomes?
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The Power of Real World Data to Study Women’s Health at Scale
Veradigm examines key clinical trends, comorbidity profiles, and treatment trends across adolescence, reproductive years, and peri-/post-menopause. Download it today!
HealthJoy, Cost Plus Drugs Partner To Reduce Drug Costs for Employers
HealthJoy and Mark Cuban Cost Plus Drug Company have teamed up. Through the partnership, HealthJoy can now direct the employees of its clients to the drug company when it offers a cheaper option for generic drugs.
An Upcoming White House Decision May Jeopardize Americans’ Access to Life-Saving Drugs
The White House might soon finalize a rule that will either save or cost patients billions of dollars in prescription drug costs. The rule concerns “copay accumulators,” which are programs health plans use to prevent copay assistance from counting toward patients’ deductibles or out-of-pocket maximums.
19 Senators Urge HHS to Drop Appeal That Would Jeopardize Americans’ Access to Life-Saving Drugs
A bipartisan group of senators sent a letter to HHS asking it to rethink its appeal of a recent federal district court decision that limits the use of “copay accumulators" — which are programs insurers use to prevent medication copay assistance from counting toward patients’ deductibles or out-of-pocket maximums.
One VC Firm’s 5 Healthcare Predictions for 2024
Executives at LRVHealth expect to see a continued focus on generative AI, increased enrollment in Medicare Advantage and more in 2024.
Which Drugs Are Driving Next Year’s 3.42% Increase in Hospital Pharmacy Spend?
Hospitals’ pharmacy spending is projected to rise by 3.42% next year, according to a new report. Specialty drugs, including Ozempic and Humira, as well as neurology medications are the primary drivers of this increase in pharmacy expenses.