The Million-Dollar Prescription: How Orphan Drugs Are Redefining Employer Risk. One employee, one prescription, and a decision that can affect a health plan strategy for the year ahead. A moment like this is one that many employers are encountering as specialized therapies become increasingly available.In Benefits Architecture: Understanding the Life of a Medical Claim, we […]

The $300,000 Difference: Managing the Cost of Specialty Drugs. It often starts with a diagnosis. An employee receives news that changes everything. It might be breast cancer, multiple sclerosis, rheumatoid arthritis, or another condition that requires advanced treatment.Their physician may recommend a specialty therapy – targeted medication designed to treat complex diseases more effectively than […]

Pharmacy Benefits Are Changing – Is Your Plan Ready? Many employer health plans appear financially stable – until they aren’t. Like the weather, conditions can look calm, then change quickly. One year, pharmacy costs may track closely with expectations. The next, a handful of high-cost prescriptions or a newly approved therapy can drive spending higher.A […]

Beyond the Coin Flip: Building Sustainable Healthcare in an Unpredictable Market. For many employers, healthcare has started to feel like a coin flip. Some years, you “win.” Claims are manageable and utilization trends are steady. Other years, you “lose.” A handful of high-cost claims hit, specialty pharmacy spend spikes, and costs surge. Yet, no matter […]

The GLP-1 Boom: A Breakthrough With a Growing Blind Spot. Medications like Ozempic, Wegovy, and Mounjaro are changing how many people manage type 2 diabetes, helping improve blood sugar control and, in many cases, support weight loss. The breakthrough has gained attention across the United States and made GLP-1 medications one of the fastest-growing drivers […]

Understanding Prior Authorization in Pharmacy Benefits. Heading to the pharmacy to fill a prescription only to be told it needs prior authorization can be frustrating for employees, but it is an important step in the healthcare system.In many pharmacy benefit plans, prior authorization is a built-in review step designed to ensure certain medications are safe, […]

Navigating Prior Authorization: A Checkpoint on Your Healthcare Journey. Just like planning a road trip, navigating a medical plan involves important checkpoints along the way. With employee benefits, one of the most important checkpoints is prior authorization, a step that helps ensure the care provided is safe, appropriate, and aligned with the plan’s benefits.Before certain […]

Sustainability and Your Benefits Program. Heading into 2024 has many C-suite leaders worried. As the economy continues to slow and inflation proceeds to rise, some businesses are struggling to foster company growth, and while adapting budgets and managing costs are top of mind during these times, it is important not to overlook your employee benefits […]