Episode 61 - GLP-1s, Biosimilars and Pharmacy Spend: Insights From Employers Health's Book of Business
In this episode, Employers Health’s analytics and clinical leaders, Jack Solomon and Hannah Weitzel, discuss how data‑driven strategies are shaping pharmacy spend, focusing on GLP‑1 weight‑loss drugs and autoimmune biologics. They reveal that about 60% of their client base now excludes weight‑loss coverage, while those that do cover see a $20‑$30 per member per month cost even after rebates, prompting tighter prior‑authorization controls. Upcoming price cuts from Novo Nordisk and Eli Lilly are expected to lower front‑end costs for patients and reduce rebate volumes, potentially easing financial constraints on clinical management. The team also highlights early success with a new Stelara biosimilar program, illustrating how biosimilars can curb specialty spend in autoimmune conditions.
Ep. 4 - Cost-Plus Pricing: What Plan Sponsors Should Know
In this episode of Benefits Bites, hosts Madison and Mike unpack cost‑plus pricing, a model gaining traction through entities like Mark Cuban’s Cost Plus Drug Company and state legislation mandating reimbursements based on NADAC plus a dispensing fee. They explain...
Ep. 4 - Health Care Headlines LIVE at the 2026 Annual Benefits Forum
In this live episode of Healthcare Headlines, hosts Mike and his co‑host review the rapidly evolving benefits landscape, tracing it from the simple formulary decisions of 20 years ago to today’s complex mix of federal and state legislation, specialty drugs,...
Episode 60 - Stop Loss Insurance: What Employers Should Know
In this episode, host Mike Stahl talks with Ryan Seamers, founder of Aegis Risk and a leading expert on self‑funded health plans and medical stop‑loss insurance. They discuss the 2026 stop‑loss renewal cycle, noting a sharp premium increase driven by...
Episode 59 - How Clinical Insight Drives Better Pharmacy Outcomes with Employers Health
In this episode, Kevin Wenceslau, Director of Clinical Solutions at Employers Health, explains how their clinical team uses evidence‑based insight to shape pharmacy benefit strategies for employers. He highlights their proactive utilization management—building custom clinical edits, collaborating with PBMs, and...
Ep. 3 - Appropriations Bill, FTC Settlement and TrumpRx Updates: What We Know So Far
In this 17‑minute episode, Mike and Madison break down three hot federal health‑care topics: the upcoming appropriations bill and its potential impact on pharmacy‑benefit funding, the recent FTC settlement affecting pharmacy benefit managers, and the latest developments surrounding TrumpRx. They...