Employer Pharmacy Benefits Articles

Cost intelligence, PBM strategies, and pharmacy benefit management for employers and HR teams.

Pharmacy Costs

Biosimilars in 2026: How Employers Are Capturing Humira, Stelara, and Eylea Savings Amid PBM Rebate Tensions

Employers in 2026 are saving millions by steering Humira, Stelara, and Eylea claims to biosimilars while confronting PBM rebate pressure and formulary barriers.

April 25, 2026
Benefits Guide

How to Evaluate Carve-In PBM Models in 2026: Integrating Medical and Pharmacy Data Without Losing Cost Control

How to assess carve-in PBM models in 2026 by aligning medical and pharmacy data without giving up rebate transparency or cost control.

April 20, 2026
Pharmacy Costs

2026 PBM Spread Pricing Crackdown: How Employers Are Leveraging Pass-Through and Transparent Models to Reclaim Lost Pharmacy Dollars

Employers are ditching spread pricing PBMs in 2026 for transparent, pass-through contracts to recover hidden pharmacy dollars and cut true net costs.

April 18, 2026
Benefits Guide

Guide to Managing GLP‑1 Coverage in 2026: Cost Controls, Clinical Criteria, and Communication Strategies for Employer Plans

How employers in 2026 can manage rising GLP‑1 drug costs with smart plan design, clinical criteria, and employee communication strategies.

April 15, 2026
Cost Control

Generic Substitution Policies That Work: Therapeutic Interchange, Step Therapy, and Quantity Limits Done Right

How to design generic substitution policies that lower pharmacy costs without disrupting employees: best practices for step therapy, therapeutic interchange, and quantity limits.

April 7, 2026
Conditions

How to Tailor Formulary Exclusions Without Creating Employee Nightmares

Many mid-size employers exclude drugs to cut pharmacy costs, but blanket exclusions can backfire. Learn how to tailor exclusions for cost and employee impact.

April 6, 2026
Employee Comms

Helping Employees Use Manufacturer Copay Assistance Programs: The Employer Guide to Patient Assistance Navigation

Practical steps for HR and benefits leaders to help employees access manufacturer drug copay assistance and patient assistance programs, with real-world examples.

April 2, 2026
Benefits Guide

Pharmacy Benefit Carve-Out from Medical: Real-World Wins, Pain Points, and How to Decide

Should you carve pharmacy out from your medical plan? Real numbers, pitfalls, and the exact steps to decide if a carve-out saves money for your company.

March 31, 2026
Cost Control

Mandatory Mail-Order Pharmacy: Real Savings, Real Trade-Offs, and How to Get It Right

Mandatory mail-order pharmacy programs can deliver savings, but real-world data shows trade-offs with employee satisfaction. Here’s what works, what doesn’t, and how to decide.

March 26, 2026
Pharmacy Costs

The Hidden Costs of Prior Authorization: When Saying Yes Can Save More Than Saying No

Prior authorizations may control drug spend, but hidden costs from administrative burden and treatment delays can quietly erode expected savings for employers.

March 25, 2026
Benefits Guide

Evaluating Pharmacy Benefit Consultants: Spotting Real Advice vs a PBM Sales Pitch

How to tell real pharmacy benefits consulting apart from PBM sales spin, with hard questions, benchmarks, and one must-do step for HR and benefit managers.

March 24, 2026
Transparency

CMS Transparency in Coverage: What Machine-Readable Files Reveal About Your Pharmacy Benefit

CMS Transparency in Coverage files expose your pharmacy pricing and PBM contract quirks. Here’s what employers see, and how to use (or misuse) the data.

March 23, 2026
Employee Comms

Communicating Pharmacy Benefit Changes to Employees Without Causing a Revolt: Messaging Templates and Timing

Strategies, templates, and timing tips for HR and benefits leaders to communicate pharmacy benefit changes without employee backlash. Real-world tactics inside.

March 19, 2026
Plan Design

Formulary Management: How to Cut Pharmacy Spend Without Creating Employee Headaches

Formulary tweaks can trim pharmacy spend by 8-15%, but missteps spark employee noise. Here’s how to save money without spiking complaints or HR headaches.

March 18, 2026
Benefits Guide

Running a PBM RFP: The Questions to Ask, the Guarantees to Demand, and How to Compare Apples to Apples

PBM RFPs can get messy fast. Here’s how to ask the right questions, demand real guarantees, and make valid comparisons, without missing the practical details.

March 17, 2026
Specialty Drugs

Why Where You Infuse Biologics Matters: Site-of-Care Optimization for Employer Health Plans

Site-of-care strategies can cut specialty drug infusion costs by 50% or more. See real numbers, PBM tactics, and pitfalls for mid- and large employers.

March 16, 2026
Pbm Contracts

Reading the Fine Print: PBM Contract Clauses That Cost Mid-Market Employers $150K–$400K Annually

An overlooked PBM contract clause cost a 550-life manufacturer $312,000 last year. Read how fine print can add six figures to mid-market pharmacy spend.

March 15, 2026
Benefits Guide

How to Benchmark Your Pharmacy Spend Against Industry Peers

Learn practical steps to benchmark your pharmacy spend using PMPM, GDR, specialty share, and mail-order rates for informed benefits management.

March 14, 2026
Pharmacy Costs

The Real Cost of Pharmacy Benefits: Why Your PEPM Spend Is Higher Than You Think and Where the Money Leaks

Discover why your pharmacy PEPM spend might be higher than expected and uncover common areas where money leaks in your pharmacy benefits plan.

March 14, 2026
Pbm Contracts

PBM Rebates Explained: Where Manufacturer Money Actually Goes and How Much Reaches the Plan

PBM rebates can look like big savings, but most employers see far less than manufacturers pay. Here’s how rebate dollars really flow, and what plans can do.

March 11, 2026
Data Analytics

Using Claims Data to Find Pharmacy Savings: The Five Reports Every Benefits Manager Should Pull Quarterly

Many employers miss six-figure pharmacy savings by not reviewing these five core claims reports each quarter. Here’s how to spot waste and act on it.

March 5, 2026
Pharmacy Costs

Self-Funded vs Fully Insured Pharmacy Benefits: Total Cost Comparison for 200–2,000 Employee Companies

Should your 200-2,000 life company self-fund pharmacy benefits or stay fully insured? Real-world cost comparisons plus practical advice from a pharmacy benefits consultant.

February 25, 2026
Regulation

The Inflation Reduction Act Pharmacy Provisions: Employer Plan Impact, the $2,000 Cap, $35 Insulin, and What’s Next

What the Inflation Reduction Act really means for employer pharmacy plans: $2,000 out-of-pocket cap, $35 insulin, and what HR leaders need to prepare for next.

February 17, 2026
Biosimilars

Biosimilar Adoption Is Saving Employers 40–70% on Biologics: Where the Best Alternatives Are Right Now

Biosimilar adoption is delivering 40–70% savings on biologics for employers. Which drug classes now offer real alternatives, and where do the biggest opportunities lie?

February 7, 2026
Transparency

Pass-Through PBM Pricing vs Traditional Spread Pricing: The Math You Need Before Switching

Pass-through and spread pricing in PBM contracts can swing costs by six figures. See the math, pros, and pitfalls before you make the switch.

January 30, 2026
Specialty Drugs

Specialty Pharmacy Spend Now Exceeds 55% of Total Drug Costs for Most Employers: What to Do About It

Specialty drugs now account for over half of employer pharmacy spend. Here’s what HR and benefits leaders can do to control costs without sacrificing care.

January 22, 2026
Plan Design

Pharmacy Benefit Plan Design for 2026: Copay Structures, Coinsurance Tiers, and Specialty Carve-Outs That Actually Control Spend

Avoid costly plan design mistakes in 2026 pharmacy benefits. Get real advice on copays, coinsurance, and specialty carve-outs that actually reduce spend.

January 14, 2026
Pharmacy Costs

GLP-1 Drugs Are Wrecking Pharmacy Budgets: How Employers Are Managing Semaglutide and Tirzepatide Costs Without Banning Coverage

One mid-sized employer spent $320,000 on GLP-1s in 2023. Here’s how benefits leaders are reining in semaglutide and tirzepatide costs, without excluding coverage.

January 6, 2026