Specialty drugs now exceed 50% of employer pharmacy spend. With oncology, GLP-1s, and $3 million gene therapies in the 2027 pipeline, here's what self-funded employers need to do before it hits.
Most PBM rebate guarantees protect the PBM, not your plan. Here's the specific contract language, audit rights, and reconciliation clauses that actually ensure rebates flow back to you.
The CAA of 2026 gives employers new audit rights and transparency mandates for PBM contracts. Here are the specific terms worth renegotiating before your January 1 renewal.
Carve-out gives you PBM contract transparency and audit rights. Carve-in shows a 17.7% reduction in hospitalizations. For a 250-life employer, the wrong default costs $400 PMPY.
Your PBM's 100% rebate pass-through contract may be technically accurate and still hiding millions in retained margin. Here's how GPO entities extract fees before the pass-through clock ever starts.
