Insights
What we’re watching
Pharmacy benefits are changing fast. Explore our perspective on the clinical, financial and operational decisions behind better PBM performance, and see how we support members along the way.
From Rejection to Protection: What Pharmacy Transparency Should Really Show
Pharmacy transparency should show more than what a plan spent after the fact. It should reveal where clinical risk was identified, where a claim was corrected and how the pharmacy benefit protected the member and the plan before a medication was dispensed.
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As Direct-to-Consumer Pharmacy Grows, Who Is Safeguarding Patient Safety?
Direct-to-consumer pharmacy models can improve access and affordability, but they can also fragment a member’s medication history. When cash-pay prescriptions sit outside the pharmacy benefit, plans need a way to preserve clinical oversight for interactions, duplicate therapies and dosing risks.
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Direct-to-Consumer Models
GLP-1s
Medication Safety & Prevention
Hidden Drivers of Pharmacy Costs in PBMs and How to Fix Them
Pharmacy costs in PBMs are not driven by pricing alone. They are also shaped by how prescriptions are evaluated as they move through the system. In this article, Dr. Martty Martinez-Fraticelli explains how overlapping therapies, misapplied clinical criteria, and other drug-related problems can…
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Cost & Utilization Management
Medication Safety & Prevention
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