Cigna will exit the ACA individual exchange market by 2027 and has already launched Evernorth Signature Pharmacy Benefits Services, a rebate-free PBM model, which will become the standard model for all clients in 2028.
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Andrew Mellin, M.D., discusses Surescripts’ pilot program for prior authorization system, which pulls clinical data from EHRs and matches it against payer criteria.
Rebates aren’t disappearing, but PSG's 2026 survey suggests payers increasingly favor lower net costs, biosimilars and price transparency over traditional specialty drug rebate programs.
This action follows an Executive Order issued earlier this week to speed review of psychedelic drugs that have shown potential to treat serious mental health issues
Major health insurers say they have cut prior authorizations, but the AMA says physicians report that the burden of prior authorization remains high.
Regeneron is making Otarmeni, which treats patients with biallelic variants in the OTOF gene, available at no cost. This is the second therapy that was approved under the FDA’s new National Priority Voucher program.
In an earning call, UnitedHealth Group executives, including CEO Stephen Hemsley, discussed the company’s strategy, which is focused value-based care, its Medicare Advantage programs transparency, AI and its transparency efforts.
PBMs have launched clinical programs pairing GLP-1 prescriptions with pharmacist coaching, nutrition support, behavioral health partnerships, and digital tools to improve adherence and outcomes.
Yuvezzi treats presbyopia, or blurry vision due to aging, and is available at retail pharmacies or PHIL, an ePharmacy platform.
Novo Nordisk is offering the subscriptions through telehealth providers Ro, WeightWatchers and LifeMD. Others are expected to follow.
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Eli Lilly's once-daily oral GLP-1, orforglipron, awaits FDA approval in April 2026. New research shows orforglipron outperforms oral semaglutide for lowering A1C and for weight loss.
More than half of people in a recent survey said they find it difficult to find the lowest-cost option for their medications, and they don’t trust that they are paying the lowest price.
Lynavoy is used to treat cholestatic pruritus, an extreme itch that affects almost 90% of patients with primary biliary cholangitis.
Prime Therapeutics’ IntegratedRx gives prescribers and pharmacists a shared, real-time view of patient records, improving patients’ experience and better outcomes.
Two surveys from West Health and Gallup find that healthcare affordability is a significant economic issue that affects nearly every aspect of life.
Abarca Health CEO Jason Borschow says making prior authorization frictionless will require trusted frameworks for exchanging data and decision-making that both payers and providers align on.
David Cordani is retiring after 17 years in the CEO role. he will join the board of directors as executive chair.
Sharon Faust, of Navitus Health Solutions, said in an interview that employers, health plans and manufacturers must work together to manage costs and access for patients taking GLP-1 medications.
Leaders of the smaller PBMs say they’ve always been transparent, pass-through companies, and complying with the new law’s reporting requirements is not a heavy lift.
Senators Elizabeth Warren and Josh Hawley have introduced bipartisan legislation that addresses a system that they say adds costs and leaves independent doctors and pharmacists unable to compete.
During an investor call, CVS Health executives said the new legislation requiring changes in PBM business practices was manageable, but they expressed some concern about CMS’s Medicare advanced rate notice.
A recent analysis shows that most products subject to price reduction under the Inflation Reduction Act have achieved substantial returns on investment by the time of negotiations.
PBM reform has finally made its way through Congress and was signed into law by President Donald Trump. Here are seven things you need to know about the law.
Cigna reported 11% revenue growth for 2025. Company executives focused on several key issues in its call with investors: its settlement with the Federal Trade Commission, a transformation announced last year to move to a rebate-free model in pharmacy benefits, and a focus on patient affordability.
Express Scripts agreed to overhaul its business model, ensuring patients pay the lowest available price for medications and reimbursing community pharmacies based on actual costs.
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