MHE July 2025

Healthcare organizations are finding that their data foundations are not as solid as they expected.

Proponents say direct-to-consumer sales by drugmakers cut out intermediaries that add needlessly to prices. Detractors see ethical issues and prices that are still too high for many patients.

Employers, some lawmakers and others have criticized pharmacy benefit managers (PBMs), especially the "big three," for having complicated, sometimes hidden practices. The PBMs say they have responded with programs and policies that add transparency to what they do.

For payers, claims for rare disease treatments used to be uncommon. Not anymore, thanks to an increasing number of new, high-priced drugs for rare diseases.