Learn how Express Scripts by Evernorth can help plans succeed in the complex world of government-regulated health care

October 8, 2024

marketplace medicaid Medicare

The world of Regulated Markets is constantly changing. Express Scripts by Evernorth offers the expanded capabilities you need to succeed in today’s regulated space by turning insightful data into innovative solutions that drive affordability and opportunities for better member outcomes.

Watch now: https://bit.ly/3swVK23

legislation

Virginia and Hawaii Introduce PDAB Legislation

The Virginia Senate introduced a bill to establish a Prescription Drug Affordability Board (PDAB) to review drugs with a wholesale acquisition cost (WAC) of $60,000 or more per year or a WAC increase of $3,000 or more in any 12-month period. For drugs deemed to cause an affordability challenge, the legislation authorizes the PDAB to […]
read more >

February 12, 2026

EGWP marketplace medicaid Medicare

Solutions

AHIP Shares Update on Plan Progress to Simplify Prior Authorization

AHIP shared progress on the voluntary, multi-year commitments made by AHIP, BCBSA, and leading health plans (including Cigna Healthcare) to streamline and simplify prior authorization. Health plans serving nearly 270 million Americans are participating in this initiative. The 2026 commitments took effect on Jan. 1 and include: reducing the scope of claims subject to prior […]
read more >

February 12, 2026

EGWP marketplace medicaid Medicare

legislation

DOL Issues Proposed Rule on Improving Transparency into PBM Fees

Pursuant to President Trump’s Executive Order “Lowering Drug Prices by Once Again Putting Americans First,” the Department of Labor’s (DOL’s) Employee Benefits Security Administration (EBSA) issued a proposed rule that would require providers of PBM services and affiliated entities of brokerage and consulting services to disclose direct and indirect compensation to their self-funded ERISA fiduciary […]
read more >

February 12, 2026

EGWP marketplace medicaid Medicare

You may also like

Solutions

AHIP Shares Update on Plan Progress to Simplify Prior Authorization

AHIP shared progress on the voluntary, multi-year commitments made by AHIP, BCBSA, and leading health plans (including Cigna Healthcare) to streamline and simplify prior authorization. Health plans serving nearly 270 million Americans are participating in this initiative. The 2026 commitments took effect on Jan. 1 and include: reducing the scope of claims subject to prior […]
read more >

February 12, 2026

EGWP marketplace medicaid Medicare

perspectives

PCMA Highlights Analysis Finding Government Mandates Will Limit Choice and Raise Costs for Employers

PCMA highlighted a new analysis by Matrix Global Advisers (MGA) concluding that placing government mandates on private market contracts between PBMs and employers would significantly harm employers, increase administrative burdens, and reduce plan flexibility. The analysis also found that many employers will see fewer savings in their prescription drug benefit, which may also mean higher costs […]
read more >

February 11, 2026

EGWP marketplace medicaid Medicare

perspectives

AHIP Continues to Raise Awareness of Cost Impacts if Congress Fails to Extend ACA Health Care Tax Credits

AHIP highlighted multiple media reports this week noting that millions of Americans are getting “their first look at the sharp increases many will pay” if Congress fails to extend the enhanced premium tax credits that have made comprehensive, high-quality health care coverage affordable for 22 million Americans. The Associated Press reports that the expiring subsidies means […]
read more >

November 13, 2025

marketplace

survey results

AHIP/BCBSA Release New NSA Findings

On Oct. 24, AHIP and the Blue Cross Blue Shield Association (BCBSA) released findings from their 2024 No Surprises Act (NSA) survey, which revealed that nearly 40% of surprise billing disputes submitted to the federal Independent Dispute Resolution (IDR) process in 2024 were ineligible under the NSA. More than half of these ineligible disputes still […]
read more >

November 13, 2025

EGWP marketplace medicaid Medicare

Solutions

The M3P Solution is Making Waves!

On Jan. 1, 2025, Express Scripts successfully launched the M3P solution to nearly all Medicare Health Plan clients – plus the entire EGWP line of business. By the end of Q4, an impressive 76,744 members had opted in. We’re proud to lead the industry in repayment rates, with 96% of members paying their billed amounts […]
read more >

November 13, 2025

EGWP Medicare