California's prescription drug mandates apply to fully-insured plans regulated by DMHC and CDI, where drug costs hit $14.9 billion in 2024. Self-funded ERISA plans are largely exempt, and that gap has real cost implications for California employers.
U.S. drug prices averaged 278% of OECD comparison country prices in 2022, with brand-name drugs hitting 422%. Here's what that gap costs self-insured mid-market employers and what you can actually do about it.
Self-funding doesn't automatically cut your health plan costs. It gives you the data, contract flexibility, and decision rights to cut them yourself. Here's what that actually means.
You signed one PBM contract, but two more run your pharmacy spend: affiliated specialty pharmacies and offshore rebate GPOs you never signed. Here's the full stack, and what to demand before you renew.
