Health plan prescription drug formularies continue to increase in complexity, and changes to those formularies are especially challenging for consumers to navigate. Those were among the highlights of ...

Ed’s stories explore prescription drug pricing, affordability and access, as well issues surrounding patents, litigation, and legislation. He is also the author of the morning Pharmalittle newsletter ...

As more states turn to Medicaid managed care as a solution to rising costs, policymakers must consider both the economic and the clinical implications of their decisions. The findings here suggest ...

Access to medicines in Medicare is reduced as the IRA is implemented Fewer drugs are covered on Medicare Part D formularies in 2025 relative to 2024 Medicines for serious conditions with high unmet ...

As health care moves toward a value-based payment model, the pharmacy benefit is going in the opposite direction, one that places unit cost over clinical appropriateness. Have you ever used your drug ...

The three largest pharmacy benefit managers — Caremark, Express Scripts and Optum Rx — each excluded more than 600 drugs from their 2026 formularies, reflecting shifts in drug pricing models that are ...

Figuring out how to pay for your prescription medicine is a complicated task. That’s because drug prices and payments are negotiated as part of a package of drugs that are covered by the insurer ...

With appreciation for feedback from Mark Fendrick, Director of the Value-Based Insurance Design (V-BID) Center at the University of Michigan, and Daneen Seekoni, Vice President of Policy and Advocacy ...

Medicare offers some exceptions to beneficiaries, including formulary, tiering, and continuing employment. Generally, Medicare has set rules and regulations. However, there are times when it makes ...

Currently, there‘s no universal Medicare drug price list available, as drug costs and availability vary according to the private insurer administering the Part D prescription drug plan. Contact Part D ...

When it comes to your medication, it’s important to be clear on what your insurance company will pay for and what they won’t. Prescription drugs can be costly, especially if you don’t have insurance.