The New Reality of Direct-to-Consumer Drug Marketing

The Next Wave of PBM Reform

Drug costs continue to surge, regulatory winds are shifting, and employers are bracing for steeper expenses ahead. Now more than ever, your choice of PBM partner can be a major differentiator or a liability. Why This Moment Matters Cost growth expectations are steep. Employers are forecasting higher health care costs in 2026, with pharmacy spend as a central contributor. Some projections suggest pharmacy alone may rise by double digits next year, far outpacing general medical cost trends. Reform pressure is building. PBM practices are under increasing scrutiny. Policymakers, physician groups, and pharmacy organizations are pushing for reforms that would delink PBM profits from drug list prices, increase transparency, and ensure savings flow to plan sponsors and patients. PBMs themselves are already floating proposals to adjust their practices ahead of possible legislation. Regulation is becoming inconsistent and complex. While federal courts and Congress weigh in, states continue to pass new PBM laws. For multi-state employers, this means navigating a patchwork of rules that can be confusing, sometimes conflicting, and potentially at odds with fiduciary obligations. What to Look for in a PBM Partner Given this evolving landscape, employers should place extra emphasis on: Regulatory agility and compliance support Your PBM must help you navigate both federal and state-level requirements, protecting your plan against compliance risk. True cost transparency and incentive alignment Demand clarity on how your PBM is compensated. Incentives should be aligned with your plan, not tied to higher drug list prices or opaque rebate arrangements. Formulary integrity and clinical governance With expensive therapies hitting the market, your PBM should balance cost savings with clinical appropriateness, ensuring members receive the right drug, not just the cheapest option. Benefit design flexibility Rising costs require innovative plan designs such as specialty carve-outs, differential cost-sharing, or utilization management. Your PBM should be a partner in shaping these strategies, not a barrier. Member experience and adoption tools With members facing higher cost-sharing and more complex therapies, digital tools, adherence programs, and proactive engagement are essential for better outcomes. Proven performance and benchmarking In this climate, results matter. Your PBM should demonstrate measurable cost savings and clinical outcomes year over year, benchmarked against peers. The Bottom Line  Plan sponsors are entering a pivotal moment. The forces shaping pharmacy benefits include cost escalation, regulatory change, and clinical complexity. The status quo will not be enough. Choosing a PBM partner with regulatory foresight, aligned incentives, clinical integrity, and member-centric tools can help employers navigate this era, mitigate risk, and deliver sustainable value to their workforce. Sources Reuters – Pharma middlemen propose regulatory changes to avoid Trump administration rules Pharmacy Times – Pharmacy policy updates for September 2025 Bloomberg Law – Drug benefit compliance is a state-by-state test for sponsors NASPA – Over 100 pharmacy organizations urge PBM reform AMA – Advocacy update spotlight on PBMs Healthcare Dive – Employers expect 9% higher health costs in 2026 WorldatWork – Business Group on Health predicts 9% higher healthcare costs in 2026 PwC – Behind the numbers: Rising drug spend ProCare Rx PBM 101 video script

The world of pharma is evolving quickly, with direct-to-consumer (DTC) marketing and new patient engagement strategies changing how therapies are launched, prescribed, and accessed. Join John Drakulich for an insightful conversation on The New Pharma Playbook and what these shifts mean for employers, health plans, pharmacies, and patients. Hosted by ProCare Rx , this webinar takes a closer look at how DTC marketing influences prescribing behavior, patient decision-making, and overall drug costs, and how transparent PBM strategies can help plan sponsors navigate these challenges while prioritizing member care. Attendees will walk away with practical insights into how PBMs like ProCare Rx are driving innovation, improving access, and keeping costs under control in a changing marketplace.

PBM 101, Part 1: Why PBMs Matter for Employers

ProCare Rx appoints Marco Torelli as new SVP of Labor and Public Sector

ProCare Rx Names JD Edwards Senior Vice President of Sales

This appointment brings together multiple parts of the business under one umbrella to best serve our PBM clients and members, assuring that ClearSight transparency and Lowest Net Cost remains at the forefront of the innovative organization.

When Courts and Care Collide: What the Arkansas PBM Ruling Means for the Industry