Insights

Get the Full Analysis of other Formulary Changes: CVS Caremark Optum Rx The following is an…

A 400% utilization spike for a single drug outlier was identified through Artemetrx, allowing the plan to promptly prevent further leakage. The Challenge…

Payer Considerations and Next Steps for the NCPDP D.0 to F6 Compliance Key Points: This is more than compliance. F6 is an opportunity to…

The specialty drug pipeline is accelerating—and the financial implications for plans are significant. With new GLP-1 formulations, MASH therapies, and cell and gene therapy…

How Payer Feedback Can Help Improve the Pharmacy Benefit Management Industry As pharmacy benefit management continues to evolve, the latest findings from the…

For over two decades, hormone replacement therapy (HRT) has been shadowed by cautionary tales and black box warnings. These warnings – rooted in early…

Avoid Costly Errors with Proactive Pharmacy Benefit Claims Validation Key Points Claims validation helps uncover discrepancies that impact plan performance and member experience. Thorough…

Operational Excellence is Essential for Plans and PBMs Key Points The Medicare Transaction Facilitator (MTF), fully operational in 2026, requires plans and PBMs to…

Three New HAE Therapies May Increase Benefit Spend For Payers Hereditary Angioedema, or HAE, is a genetic condition that is very rare and…