Peter Wehrwein

The president of Vivid Clear Rx says PBMs should limit point solutions early on and warned against farming out too many services to vendors that a PBM should provide itself.

The program reduced per-episode spending as intended, the researchers found. But those savings were offset by bonuses paid to hospitals for beating financial benchmarks, leading to a net loss.

Kessler, a principal at Milliman, says employers need to pay attention to their claims and pharmacy benefit contracts.

As PBMs plan for 2028 rollout of the PBM transparency provisions of the Consolidated Appropriations Act of 2026 (CAA 2026) cost-plus pricing will flip how drug costs look on paper, requiring far more data, says Milliman principal Kessler.

In the second part of an interview with Managing Editor Peter Wehrwein, Paulus talks about the role of PBMs and aligning providers with payers.

The plaintiffs in Kelley v. Becerra are arguing that the Affordable Care Act's requirement that preventive services be covered without cost sharing is unconstitutional. In a factsheet published yesterday, the Urban Institute says that the ACA requirement has had an especially a large effect on women, partly because contraception is among the services covered by the no-cost-sharing rules that apply to private insurers.

As PBMs plan for 2028 rollout of the PBM transparency provisions of the Consolidated Appropriations Act of 2026 (CAA 2026) cost-plus pricing will

OrionRx's Don Anderson, Pharm.D., outlines near-term and long-term fixes for the blind spots created when members buy medications outside their pharmacy benefit.

Optum Rx's Anne Mall, MHA, says her company's AI is surfacing clinical details buried in providers' chart notes so clinicians can decide on therapy faster.

Optum Rx's PreCheck Prior Authorization tool automates 64% of approvals in under 30 seconds, getting patients onto therapy four days faster, Anne Mall, MHA, says.