Most self-funded employers can tell you what they pay in premium equivalents and administrative fees. Far fewer can tell you what their pharmacy benefit manager (PBM) actually earns on their plan, because that number is rarely in the contract in plain language. Two...

Every self-funded employer is feeling the same pressure right now. GLP-1 claims are landing on renewals in numbers nobody budgeted for, specialty drug costs keep climbing faster than wages, and a single high-cost claimant can undo a year of otherwise disciplined plan...

A few years ago, GLP-1s were a diabetes drug most benefits leaders barely thought about. Today they are reshaping pharmacy budgets across the country, and they will not be the last drug class to do it. Gene and cell therapy costs, already running into the millions of...

For a self-funded employer, stop-loss insurance is the piece of the plan that makes the entire self-funding decision viable. It is also one of the least understood. HR directors and CFOs can usually walk through their plan design, network strategy and contribution...

Self-funded employers put a lot of work into designing a health plan that works well for their employees and their families. Keeping that plan running accurately over time is an equally important part of the job, and dependent eligibility is one area where enrollment...

Healthcare costs continue to climb, and self-funded employers are looking harder than ever at strategies that deliver meaningful savings without compromising the member experience. Reference-based pricing (RBP) has become one of the most discussed options in that...