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.
GLP-1 usage doubled in less than two years. Before you finalize your 2027 formulary, here's how to build structured coverage that doesn't blow your pharmacy budget.
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.
GLP-1 drugs now make up 20-25% of pharmacy spend on some employer plans, with costs jumping 50% in 2025. Here's how to find your number and manage it without blanket denials.
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.
