Mar 9, 2026 | Compliance, Consolidated Appropriations Act of 2021 (CAA), Pharmacy Benefits Manager (PBM), Prescription, Primary Care, RxDC report, Specialty Care, Third party administration
As you may recall, the Consolidated Appropriations Act of 2021 (CAA) requires group health plans to submit to the Centers for Medicare & Medicaid Services information about prescription drugs and health care spending. This data submission is called RxDC (for...
Feb 5, 2026 | Compliance, Department of Labor, Employee Retirement Income Security Act (ERISA), Legislative, Pharmacy Benefits Manager (PBM), Regulatory
Pharmacy benefit managers continue to draw scrutiny in Washington, and two recent federal actions signal that greater transparency and oversight may be on the horizon. One is a newly enacted funding law that includes PBM reforms, and the other is a proposed Department...
Jan 26, 2026 | Drugmakers, Group purchasing organization (GPO), Pharmacy Benefits Manager (PBM), Rebates
An extensive investigation by Hunterbrook Media sheds new light on how the nation’s three largest PBMs may be using little-known affiliated entities – effectively middlemen to the middlemen — to quietly retain billions of dollars that employers and health plans never...
Dec 29, 2025 | MedBen Rx, Pharmacy, Pharmacy Benefits Manager (PBM), Rebates, Rx Costs, Transparency
While the major PBMs still dominate the market, their grip is loosening. A recent Pulse of the Purchaser survey found that the percentage of employers contracted with one of the Big 3 dropped from 72% in 2024 to 61% by late 2025, as more organizations shifted toward...
Dec 1, 2025 | Case Studies, Cost Savings, MedBen Rx, Patient assistance, Patient coupons, Pharmacy, Pharmacy Benefits Manager (PBM), Rx Costs, Savings
A new MedBen Rx client realized $1.19 million in combined plan and member savings in their first year – a 45.7% reduction, surpassing the $1.05 million projected savings. Per-member-per-month (PMPM) pharmacy costs tell the story: $233 under the previous PBM vs. just...
Oct 6, 2025 | Independent pharmacies, Legislative, Pharmacy, Pharmacy Benefits Manager (PBM), Prescription, State legislation
Independent pharmacies across the country are facing financial strain, with many closing their doors due to unsustainable reimbursement rates and restrictive practices imposed by the major pharmacy benefit managers (PBMs). In response, states are taking legislative...
