Findings of a survey of large employers indicate that utilization management tools are ineffective in controlling health care costs for employees and may lead to barriers to treatment. Employer ...

As healthcare costs continue to rise, businesses face increasing pressure to balance comprehensive benefits with financial sustainability. One of the most significant challenges is the escalating cost ...

Throughout 2025, Congress introduced several bills related to the pharmacy benefit management (PBM) industry. As with the 118th Congress in 2024 ...

Population health management is a perennial challenge for benefits leaders. If money were no object, a company could offer all manner of perks that might contribute to better health. But with ...

Drug utilization management such as prior authorization and stricter formularies cost the healthcare industry $93 billion annually, with patients bearing the largest share of the cost, a new study ...

Use of algorithms and artificial intelligence (AI) in prior authorization and utilization management is facing growing criticism and litigation. Notable lawsuits include alleged automatic ...

The administrative burden of utilization review processes like prior authorizations and concurrent review has long been a thorn in the side of healthcare providers. While prior authorizations have ...

Panelists at an Academy of Managed Care Pharmacy (AMCP) Nexus 2022 session discussed enhanced utilization management strategies to manage the rising cost of specialty drugs, while providing members ...

In this episode of the Becker’s Healthcare Podcast, Lukas Voss is joined by Chad Kersting, Business Development Director, and Dr. Eric Gratias, National Physician Executive of Medical Benefit Services ...

MADISON, Wis.--(BUSINESS WIRE)--Navitus, the nation’s first and largest transparent, full pass-through pharmacy benefit manager (PBM), announced today it has achieved a series of accreditations and ...