September 3, 2026

Nine mid-sized drugmakers have agreed to deals with the White House, announcing Monday they will participate in a model Medicaid program to align certain drug prices with those paid by other countries while upping manufacturing in the U.S.

More Americans are paying cash in the emergency department while fewer rely on Medicaid, showing how coverage losses in the safety-net insurance program after the coronavirus pandemic are placing more direct financial pressure on low-income patients.

Last Wednesday, Georgetown researchers published a report estimating that the independent dispute resolution (IDR) process established under the No Surprises Act has generated more than $22 billion in unnecessary healthcare spending, including $16 billion from provider awards exceeding comparable in-network payment rates. Provider organizations have disputed the findings, arguing that the analysis relies on flawed methodology. Specifically, they contend that the researchers' use of qualifying payment amounts (QPAs) does not accurately reflect appropriate reimbursement because insurers artificially suppress these benchmark rates.

The lawsuit alleges that a 2019 agreement between Express Scripts and Prime Therapeutics violated antitrust laws. Under the arrangement, Express Scripts assumed responsibility for Prime's retail pharmacy network and drug manufacturer contracting, allowing Prime to align its pharmacy reimbursement rates with those of Express Scripts while both PBMs shared in the resulting savings. Because pharmacies rely heavily on prescription dispensing revenue, the reduced reimbursement rates reportedly turned many previously profitable prescriptions into financial losses. Prime has denied the allegations, maintaining that savings generated by PBMs ultimately benefit patients through lower healthcare costs.

The continued acceleration of employer healthcare costs highlights the growing affordability challenges facing sponsors of commercial health plans. Rising pharmacy costs, particularly GLP-1 therapies, and broader healthcare system pressures may lead employers to implement benefit design changes and cost-management strategies in the coming years.