Pharmacy Benefit Managers play a major role in determining medication coverage, pharmacy access, and treatment approvals. Understanding how PBMs influence healthcare can help patients make more informed decisions about their care.
A recent House hearing exposed how PBMs pay brokers to steer employers toward expensive drug plans, raising new concerns about conflicts of interest in the pharmacy benefits industry.
Texas workers’ compensation laws protect your right to choose where you fill your prescriptions. Learn how pharmacy choice works and what to do if an insurance carrier challenges your selection.
PBMs play an important role in both private health insurance and workers’ compensation, but the systems operate very differently. Understanding these differences helps explain how medication access, costs, and patient care priorities vary.
Workers’ compensation has long operated on assumed trust for pharmacy benefit management, but heightened scrutiny is reshaping expectations.
Pharmacy Benefit Managers are facing growing legal and legislative pressure. Here is what these changes could mean for drug pricing and patient access.
Prescription drug costs continue to rise across the United States, creating pressure for patients, pharmacies, and healthcare systems alike. Growing conversations around PBM reform are bringing new attention to transparency, affordability, and the future of prescription care.
As part of EZ Scripts Pharmacy being “What a Workers’ Compensation Pharmacy should be”, we will continue on our series of Pharmacy Benefit Managers. Today, we explore the History of PBMs.
As part of EZ Scripts Pharmacy being “What a Workers’ Compensation Pharmacy should be”, we will begin a series of breakdowns of topics related to workers’ compensation. Workers’ compensation is difficult for all stakeholders, and our goal is simple, to demystify elements of a complex industry.
In 2023, PBMs like WellCareRx, PrimeCare, and MedDirect shaped U.S. healthcare, with WellCareRx leading at 34% market share. PBMs drive affordability and access, especially for generic drugs, which continues to influence workers’ compensation pharmacy services and prescription workflows for legal and medical teams.
New employees account for 35% of workplace injuries and 32% of claim costs. Key risks include falls and overexertion, with construction workers averaging 103 lost days per incident. Strong safety practices can reduce accidents and costs, especially in environments where workers’ compensation prescriptions and case coordination depend on timely reporting.
Pfizer’s new platform, PfizerForAll, simplifies U.S. healthcare access with virtual and in-person consultations, prescription delivery, and vaccine scheduling. Partnering with UpScriptHealth and Alto Pharmacy, it offers co-pay assistance and support to help patients navigate insurance and pharmacy networks. These improvements also shape how workers’ compensation prescriptions and patient access evolve within broader healthcare ecosystems.
The pharmacy industry is undergoing a drastic shift, with chains like Rite Aid, Walgreens, and CVS struggling to adapt to financial pressures and shifting consumer habits. Rite Aid’s bankruptcy and store closures, alongside Walgreens and CVS scaling back underperforming locations, highlight the urgent need for new strategies to stay competitive.
David moved to Jacksonville seeking a fresh start, but soon the same hopelessness returned as his attempts to find mental health care hit dead ends. On a rough night, he turned to online forums, where strangers’ support reminded him he wasn’t alone—and encouraged him to keep trying, one call at a time. Stories like David’s reflect broader challenges in accessing care, especially as patients and legal or medical teams face similar delays when coordinating workers’ compensation prescriptions.
Prior authorization often delays prescriptions and treatments. Here’s what patients should know about the process and how to navigate it. These delays can also influence timelines for workers’ compensation prescriptions, where faster approvals are critical for recovery.
Your insurer may limit your access to medications through prior authorization, step therapy, high costs, or non-coverage. Learn how to navigate these barriers to get the care you need. These same insurance hurdles also affect workers’ compensation prescriptions, often slowing down care for injured workers.
Retail pharmacies are facing severe strain as rising workloads and understaffing push many pharmacists and technicians to leave the industry, raising concerns about burnout and patient care quality. These pressures also influence fulfillment pathways for workers’ compensation prescriptions, especially when retail bottlenecks slow medication access.
Medication nonadherence, especially among chronic disease patients, costs the U.S. up to $300 billion annually. Efforts to improve adherence are critical as prescription rates rise. These challenges also affect continuity of care for injured employees whose recovery depends on timely workers’ compensation prescriptions.
A recent survey shows that over one-third of Americans have skipped filling a prescription due to high costs. Support for government price caps on essential medications like insulin and cancer drugs remains strong. These affordability challenges also affect injured employees who rely on timely workers’ compensation prescriptions for recovery.
