White bagging is a new tactic by health insurers requiring certain medications to be purchased through specialty pharmacies, often owned by the insurance company, with no inpu... Continue Reading

Step therapy, or “fail first”, is a policy used by health insurers that requires patients to try and fail one or more formulary-covered medications before providing covera... Continue Reading

While PBMs were originally set up to control drug utilization and cost, they have since become incredibly effective at negotiating discounts and rebates from manufacturers tha... Continue Reading

Formulary-Driven Switching refers to a policy used by insurers to limit prescription drug coverage to the less expensive medications. It can be used to alter a patient’s med... Continue Reading

What are they? Accumulator Adjustment Programs (AAPs) are tools utilized by insurers and pharmacy benefit managers (PBMs) to exclude co-pay assistance as an out-of-pocket expe... Continue Reading