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.
AMA: PBM Market Concentration Is On the Rise
The AMA found that OptumRx, Express Scripts, CVS Caremark and Prime Therapeutics controlled 75% of the national PBM market in 2024.
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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.
Report: Employers’ Use of Big Three PBMs Falls in 2026
A new survey finds that employers are moving away from the Big Three PBMs while prioritizing healthcare affordability and transparency.
Pharmacy Benefit Operations Infrastructure Must Rise to Regulatory Reform Standards
The PBM reform efforts are directional, not temporary. Meeting these expectations requires automated systems that can reconstruct claim logic on demand and provide real-time alignment between pricing, rebates and financial outputs.
Will Tennessee’s PBM Bill Face the Same Fate as Arkansas’ Law?
Tennessee lawmakers recently passed a bill banning PBMs from owning pharmacies in the state, though like a similar Arkansas law, it is expected to face legal challenges if enacted.
Debunked Episode 24: PBM Reform Brainstorm, Elevance Faces CMS Penalty Risk, Hims & Hers’ Eucalyptus Deal Takeaways
In the latest episode of the Debunked Podcast, the discussion revolved around the Break Up Big Medicine legislation to rein in healthcare giants and ways to introduce meaningful PBM reform.
Why Pharma Companies Should Look To Social Media For Better Patient Insight
Healthcare decision-makers, especially at pharmaceutical companies, must prioritize patient input. Data collected from social media listening is a significant step in the right direction.
It Took Years for Congress to Enact PBM Transparency, Delinking. What About Vertical Integration?
Experts say the bipartisan Break Up Big Medicine Act — aimed at breaking up vertically integrated healthcare companies — faces slim chances of passing despite recent PBM reforms.
Employers Celebrated PBM Reform. The Reality Is More Complicated
The Consolidated Appropriations Act of 2026 and the Department of Labor’s proposed rule implement major PBM reforms for employers, but don’t include everything they want, including a ban on spread pricing.
Coalition of Pharmacy Groups Urges Congress to Enact PBM Reform
A coalition of major pharmacy organizations urged Congressional leaders to enact long-stalled PBM reforms to curb anti-competitive practices, lower drug costs and stop accelerating pharmacy closures that are limiting patient access to care.
President Trump Can Act Now To Make Healthcare Affordable
The Trump administration can immediately take these two price transparency administrative actions to reduce costs and improve affordability.
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Automation Didn’t Dehumanize Care. Bad Systems Did.
We have the opportunity to design systems that give people greater capacity for the work where human presence matters most: listening, understanding, reassuring, deciding, and caring.
Senators Introduce Bipartisan Bill to Increase Oversight of PBMs
A bipartisan Senate bill would boost transparency and oversight of pharmacy benefit managers by changing how they’re paid, expanding reporting requirements and strengthening protections for pharmacies and taxpayers.
The Path to Fair PBM Competition
When control over prescription drug access rests with only a few players, the result is not just market imbalance — it is higher plan costs, increased financial pressures, and ultimately reduced affordability for patients.
California Signs PBM Law: As Federal PBM Regulation Lags, the States Step Up
With federal PBM reform stalled, states like California are stepping up with laws like SB 41 to boost transparency and lower drug costs.
How Employers Can Build an Effective GLP-1 Strategy
Here are five guidelines to help employers balance health outcomes and financial responsibility to ensure that GLP-1 coverage is effective, affordable, and aligned with improved health and workforce well-being for employees and their families.
New AMA Report Highlights Lack of Competition in PBM Market
In a new analysis, the American Medical Association detailed the lack of competition among pharmacy benefit managers and their high level of vertical integration with insurers.