Author: Danna Schwerdt

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…

In today’s economic landscape, employers face mounting pressure to do more with less. Tight budgets, rising healthcare costs, and shifting workforce expectations often force companies to make difficult choices. While these decisions may be well-intentioned, they can have unintended consequences on employee morale, retention, and organizational culture. Here are five common sacrifices employers make due…

In an era of increasing healthcare scrutiny, employers sponsoring self-funded health plans are facing more pressure than ever to act in the best interests of their plan participants. Central to this fiduciary duty is the way prescription benefits are managed, and for many, the current lack of transparency in pricing is a serious risk.  What…

Employee retention is a top concern for many organizations. In today’s competitive job market, creating a work environment that fosters long-term loyalty is just as critical as recruiting top talent. Research from May 2024 reveals that 51% of U.S. employees are actively seeking or considering new job opportunities, the highest turnover risk reported in nearly…

A new trend is reshaping how specialty drugs are priced and delivered, and it is happening quietly behind the scenes. Major pharmaceutical wholesalers like Cencora, Cardinal Health, and McKesson are no longer just distributing medications. They are now investing in or managing physician practices, especially in high-cost areas like oncology, urology, and ophthalmology.  Altogether, these…

If you have employer-sponsored health insurance or a 401(k), there’s a massive piece of federal legislation quietly working behind the scenes to protect your interests: the Employee Retirement Income Security Act of 1974 (ERISA). More than just a bureaucratic acronym, ERISA is the legal foundation for most private-sector benefits. It sets the minimum standards that…

Specialty medications can be life-changing, even lifesaving, for patients with complex conditions. Yet navigating the programs designed to fund these medications can be overwhelming and confusing. Over the years, alternative funding programs (AFPs) have emerged to address rising costs, but many come with trade-offs: limited access, confusing processes, and incentives that may not always align…