In The News | Employers are rethinking pharmacy benefits: 5 things to know

Modern Healthcare

Reporter: Noah Tong

Health plans are thinking about shaking up how they manage pharmacy benefits, according to survey findings the Pharmaceutical Strategies Group published Tuesday.

Tactics under consideration to offset rising costs for employer- and union-sponsored health plans include moving toward different drug pricing arrangements, rejecting single pharmacy benefit models and embracing third-party vendors. Pharmaceutical Strategies Group is a division of Epic Insurance Brokers and Consultants.

MH Related: PBMs pivot to fees as clients, regulators shun old ways

Here are five things to know about what insurers, employers and unions think about PBMs.

1. Unbundling

More respondents see merit in moving away from PBM models they deem as fostering misaligned incentives.

Blue Shield of California, for example, operates under a fully “unbundled” model that employs multiple PBMs, although the nonprofit insurer has not yet met its savings goals.

A plurality of survey respondents — 44% of employers and 49% of health plans — said they would favor partially unbundling PBM services.

“They’re concerned about the member experience,” said Josh Van Ginkel, vice president of plan sponsor consulting for Pharmaceutical Strategies Group. “They’re concerned about tying the data together and losing data insights as they pull things apart.”

2. Drug-pricing arrangements

More health plans are in PBM contracts that include new ways of setting prices for prescription medicines: 44% are in pass-through models and 9% in cost-plus arrangements, the survey found. That’s up from 35% and 7%, respectively, in 2025. Per member, per month guarantee arrangements decreased from 18% to 11%.

3. Vendors

Outreach toward third-party vendors to contain costs is growing... Continue Reading