Expert Interviews

Dunn of NeosRx says a 340B shift from discounts to rebates likely won't affect rebate erosion affecting plan sponsors.

Five transcranial magnetic stimulation sessions in one day improved processing speed in adults with schizophrenia, which holds promise for future treatment possibilities, according to researcher Heather Burrell Ward, M.D.

Steering claims away from 340B-eligible pharmacies is one option but also the most disruptive, said Jeff Dunn, Pharm.D., MBA, of NeosRx.

340B discounts preclude rebates paid to pharmacy benefit managers for their payer clients. Dunn says new transparency and cost pressures have created awareness of “340B rebate erosion.”

Chad Hatfield, Pharm.D., M.H.A., BCPS, vice president and chief pharmacy officer of UC Davis Health, says pharmacists are embedded in “nearly all specialties," with more than 150 holding board certification.

Sova, a clinical advisor for Employers Health, expects more employers to exclude GLP-1s for obesity but urges a look at coverage for specific cardiometabolic conditions.

Employers Health’s Alexis Sova says employers excluding GLP-1s now lean on weight management programs and direct-to-employer deals, not a hard cutoff.

Poh says treatment of follicular lymphoma is entering an exciting era in follicular lymphoma with multiple treatment options and an opportunity to be selective according to what a patient wants from therapy.

The treatment landscape continues to evolve, Poh says, and move away from a one-size-fits-all approach toward more individualized treatment strategies.

Tafasitamab targets CD19, and epcoritamab targets CD20 and CD3, bringing T cells into close contact with the lymphoma cells, Poh notes.

Approximately two-thirds of Employers Health clients now exclude GLP-1s for obesity, up from a roughly even split at launch as cost drives coverage decisions.

Chad Hatfield, Pharm.D., MHA, BCPS, of UC Davis Health, discusses the system's pharmacy shared service center, embedded pharmacists and 340B rebate readiness.

A five-session course of transcranial magnetic stimulation (TMS) improved processing speed in people with schizophrenia, a cognitive domain that is among the most severely affected in patients.

Hispanic HIV incidence rose 16.8% in antisanctuary counties after the 2018 public charge announcement, relative to baseline counties, a new study found.

ProAct Chief Operating Offier Deborah Dempsey says plan sponsors still lack the data and visibility to know whether they were shorted on a 340B claim.

OrionRx's Don Anderson, Pharm.D., says a GLP-1 access model built around mandatory wellness coaching resulted in a six-point drop in body mass index and improved mental health.

Poh says there is no single algorithm that applies to the treatment for patients with relapse or refractory follicular lymphoma.

More treatment doesn't automatically mean better treatment, Poh stresses, and the combinations that can improve progression-free survival come with the risks of additional toxicity and treatment complexity.

ProAct's Deborah Dempsey, Pharm.D., MBA, RPh, explains how 340B discounts to healthcare entities are in conflict with rebates that manufacturers pay to health plan sponsors.

Optum Rx's Anne Mall, M.H.A., says her company's AI is surfacing clinical details buried in providers' chart notes so clinicians can decide on therapy faster.

Optum Rx's PreCheck Prior Authorization tool automates 64% of approvals in under 30 seconds, getting patients onto therapy four days faster, Anne Mall, MHA, says.

OrionRx's Don Anderson, Pharm.D., outlines near-term and long-term fixes for the blind spots created when members buy medications outside their pharmacy benefit.

OrionRx's Don Anderson, Pharm.D., says drugs filled outside a member’s pharmacy benefit could result in excessive and duplicative prescriptions.

As PBMs plan for 2028 rollout of the PBM transparency provisions of the Consolidated Appropriations Act of 2026 (CAA 2026) cost-plus pricing will flip how drug costs look on paper, requiring far more data, says Milliman principal Kessler.

Kessler, a principal at Milliman, says employers need to pay attention to their claims and pharmacy benefit contracts.

The president of Vivid Clear Rx says PBMs should limit point solutions early on and warned against farming out too many services to vendors that a PBM should provide itself.

Yes, breaking up is hard to do, acknowledged the president of Vivid Clear Rx. But employers should be "brave" about severing their ties to one of the “big three” pharmacy benefit managers (PBMs) and contracting with mid-size PBMs like hers, says Amy Wadstrom, RPh.

A principal and product owner at Milliman, Kessler discusses some of the reasons for heightened attention and scrutiny of plan sponsor fiduciary responsibility when it comes to pharmacy benefits.

The president of Vivid Clear Rx says finding a GPO partner whose goals align with a PBM's moves transparency forward for clients.

The president of Vivid Clear Rx says meaningful PBM transparency means pairing access to data with help from an educational partner.