Articles tagged with “drug-formulary”

Pharmacy vs. Medical Benefit Explained: GLP-1 Coverage

Learn the key differences between pharmacy vs. medical benefit and how this structure impacts insurance coverage for GLP-1 drugs for diabetes and obesity, including the 2025–2026 Medicare BALANCE Model, manufacturer price cuts, and employer coverage trends.

50 min read

11/7/2025

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Drug Formulary Tiers Explained: Step Therapy vs. PA Guide

Learn what drug formulary tiers are and how they affect prescription costs. Updated for 2026 with CMS-0057-F ePA rules, gold card laws, and IRA drug cost caps.

45 min read

11/7/2025

drug formulary formulary tiers step therapy prior authorization utilization management prescription drug costs medication adherence health insurance

Understanding Drug Formularies, Benefits, and ePA in the US

An in-depth guide to US drug formularies, pharmacy benefits, and prior authorization (PA). Learn how P&T committees, tiers, ePA systems, and the CMS-0057-F interoperability rule shape drug coverage and costs

50 min read

11/2/2025

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