Big Beautiful Bill Reduces Drugs Eligible for Price Negotiations
September 10th 2025Two separate analyses in Health Affairs find the One Big Beautiful Bill creates a loophole that exempts or delays orphan drugs — many of them blockbuster drugs that generate billions of dollars in sales — from price negotiations.
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ICER Finds GLP-1 Drugs Cost-Effective but Warns of Major Budget Strain
September 9th 2025ICER’s comparative effectiveness and value review of Wegovy, Zepbound and oral semaglutide finds they are highly effective treatments with significant health benefits, but affordability and long-term management are still unresolved.
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Stop Loss and the Surprise Claim | PBMI 2025
September 8th 2025Panelists at a session at the Pharmacy Benefit Management Institute’s annual meeting in Orlando discussed how stop-loss insurance addresses rising costs from cell therapies, oncology treatments, and orphan drugs affecting self-funded employer plans.
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Rising Cancer Drug Costs Calls for Collaboration and Value-Based Care | PBMI 2025
September 5th 2025At the PBMI annual meeting, experts warned that soaring prices for new cancer therapies require greater data sharing, precision medicine and value-based contracts to ensure patients get access to effective treatments without overwhelming costs.
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IQVIA Predicts Spending on Obesity Drugs Could Reach $60 billion by 2029 | PBMI 2025
September 4th 2025IQVIA’s Scott Briggs forecasts increased GLP-1 drug spending, limited biosimilar savings and patient adherence hurdles for novel therapies at the Pharmacy Benefit Management Institute’s annual meeting in Orlando.
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Employers Brace for Rising Drug Costs and Shifting PBM Expectations | PBMI 2025
September 4th 2025Employers face rising healthcare costs and specialty drug challenges, prompting a shift towards strategic partnerships with PBMs for better solutions, according to Karen van Caulil, Ph.D., president and CEO of the Florida Alliance for Healthcare Value, who chatted with MHE in the final installment of a two-part video interview.
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Employers Push for Transparency From PBMs | PBMI 2025
September 4th 2025Employers are demanding more transparency and partnership from pharmacy benefit managers (PBMs), according to Karen van Caulil, Ph.D., president and CEO of the Florida Alliance for Healthcare Value, who spoke with MHE ahead of her remarks at the Pharmacy Benefit Management Institute’s annual meeting in Orlando.
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Employers: Cancer, GLP-1 Drugs and Mental Health Driving Healthcare Costs
August 25th 2025A new Business Group on Health survey finds that nearly a quarter of all employer healthcare spending (24%) went to pharmacy expenses in 2024, and employers forecast an 11% to 12% increase in pharmacy costs heading into 2026.
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Health Plans Negotiate Different Prices for the Same Procedures
Published: August 18th 2025 | Updated: August 19th 2025In an analysis from Trilliant Health of 11 inpatient and outpatient procedures, Aetna and UnitedHealthcare had huge variations in rates across the country, across states, and even at the same facility for the same procedures.
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UC Davis Receives $3.6 million Grant for Eye Gene Therapy Research
August 15th 2025The UC Davis team is studying a less invasive way of delivering gene therapy to the eye: injecting the gene therapy into the suprachoroidal space, a tiny layer between the white of the eye and the blood vessels that feed the retina.
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Medicare Plans Face Higher Liability From Cap on Out-of-Pocket Drug Costs
August 14th 2025To help Medicare plans better manage members with high drug expenses, Prime Therapeutics has launched an AI-driven tool to help plans identify members likely to experience increases in pharmacy costs.
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Sharon Faust on Navigating Challenges and Opportunities in Pharmacy Benefits | PBMI Innovator
August 12th 2025In this second part of a video interview series, it was revealed that Sharon Faust, chief pharmacy officer at Navitus Health Solutions and PBMI Innovator Award winner, works to improve the pharmacy benefit system by promoting transparency, educating others about rules and supporting new business ideas that help patients and use healthcare money wisely.
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