Articles

Gene and cell therapies now run $2–4 million per treatment, and stop-loss carriers are responding with exclusions, sublimits, and lasering. Here's what self-funded employers need to know before the next renewal.

Self-funded employers can now source GLP-1s directly from manufacturers through platforms like LillyDirect, NovoCare, RxSaveCard, and Waltz Health, often below PBM net cost. Here's what the contracts, eligibility gates, and compliance risks actually look like in 2026.

Gene therapy claims are crossing $2 million and landing on mid-market employers' desks. Here's a decision framework covering medical necessity criteria, stop-loss positioning, outcomes-based contracts, and installment payment options.

The FDA has approved 83 biosimilars, but less than 10% of eligible biologic prescriptions are filled with one. PBM rebate structures keep branded biologics preferred. Here's what's driving the gap and what employers should demand at renewal.

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.

Stop-loss loss ratios have hit 85% and carriers are calling it unsustainable. Here's what's driving 2026 rate increases, from reinsurance hardening to GLP-1 claims, and what you can push back on.

Peptides are the most-watched category in pharma. The pipeline behind GLP-1s, retatrutide, orforglipron, MariTide, CagriSema, will push pharmacy spend and PBM economics into a different shape through 2030. Here's what your plan should expect.

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.