Renewal season has a way of narrowing the conversation. Spreadsheets get sharper. Timelines get tighter. Focus shifts to rates, trend, and whether the increase is “reasonable.” What often gets lost is the opportunity renewal season presents. It is one of the few moments each year when employers are expected to pause, review, and make intentional decisions…
Specialty medications are often discussed in clinical terms. Breakthrough therapies. Complex conditions. Life-changing outcomes. For brokers, however, specialty drugs represent something else entirely. They are one of the largest and least predictable sources of financial risk in employer health plans. Understanding that risk and knowing how to reframe it is quickly becoming a defining skill for effective advisors. …
For many employers, pharmacy spend is one of the least understood parts of the health plan. Reports arrive each quarter. Trends are summarized. Costs rise. But when leaders ask why pharmacy spend is increasing, the answers are often vague. Utilization. Specialty drugs. Market pressure. Those explanations describe what is happening, not where the dollars are actually going. …
Most brokers say they want to be viewed as strategic partners. Far fewer are actually positioned that way. For many employers, the broker relationship still centers on transactions. Renewals. Market checks. Carrier negotiations. Necessary work, but not the kind that earns a seat at the executive table. To become a true partner to CFOs and…
For years, prescription drug costs were treated as an unfortunate but unavoidable part of employer-sponsored health plans. Complex, opaque, and largely outsourced, pharmacy was often viewed as something to manage at arm’s length. That approach is becoming increasingly risky. As prescription drug spend continues to rise, employers are facing a new reality. Overspending is no…
For years, transparency has been treated as a checkbox in the benefits world. A contract term. A pricing model. A line in a proposal. But in today’s environment, transparency has evolved into something far more powerful. For brokers willing to use it strategically, transparency is no longer just about disclosure. It’s a way to differentiate, deepen client relationships,…
For years, pass-through pricing has been marketed as the gold standard of pharmacy transparency. Employers hear the term and assume it guarantees clarity, fairness, and alignment. Brokers hear it and often check the box; confident they’ve solved the PBM problem. But here’s the uncomfortable truth: Pass-through does not automatically mean transparent. And it certainly does not mean cost containment. Understanding the difference matters more now…
For the third consecutive year, a prospective employer group has opted to decline SHARx, despite a detailed analysis demonstrating significant cost-reduction opportunities. This decision highlights a recurring industry challenge: the “Big Three” PBMs continue to entice groups with the promise of larger rebate checks, which often distracts from the more impactful goal of lowering the…
Pharmacy Benefit Managers (PBMs) play a major role in administering prescription drug benefits, but contracts can be difficult to navigate. Packed with dense language, vague rebate terms, and limited audit rights, PBM agreements often mask costs that erode employer budgets and limit control. If you’re self-funded or considering it, understanding how to read a PBM contract is critical to…
Declining PBM rebates are forcing employers to rethink how they manage pharmacy benefits and protect budget stability. For years, rebate checks acted as a predictable offset to rising drug prices, but structural industry shifts now mean those dollars are shrinking fast. Employers who understand why PBM rebates are declining (and what new strategies they must…