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.
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.
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.
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