Articles tagged with “pbm”

PBMs Explained: Role in Drug Pricing & Healthcare System

Learn what Pharmacy Benefit Managers (PBMs) are and their role in the U.S. healthcare system. Updated for 2026 with FTC Express Scripts settlement, CAA 2026 federal PBM reform, Medicare Part D changes, and latest state regulations.

65 min read

11/7/2025

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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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PBMs Explained: Self-Funded vs. Fully Insured Health Plans

Learn how PBMs work and compare self-funded vs. fully insured health plans. Updated for 2026 with FTC settlement, federal rebate pass-through mandate, and latest KFF data on financing models, ERISA, risk, and PBM impact on drug costs.

70 min read

11/7/2025

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