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Category: Consumer / Employer

Join Us at INVEST Digital Health for a Conversation on Consumer-Centered Care across the Healthcare Ecosystem

The annual INVEST Digital Health conference is coming up! Scheduled for October 29 in Dallas at Pegasus Park, in collaboration with Health Wildcatters, consumer influence in healthcare is the theme this year. Consumers are ordering their own diagnostics, tracking their health with wearables, accessing care directly and expecting healthcare to work more like the other services they use every day. The conference will explore how the consumer experience is impacting visits to clinicians, self-insured employers, GLP-1 drug developers and more.

In a preview of the conference, we’ve included an updated list of the speakers and the agenda. In addition to the panel discussions, attendees will also be offered a tour of BioLabs, a state-of-the-art incubator lab and office space for emerging life sciences startups. They will also get the chance to view Bridge Labs, a purpose-built, institutional-quality life sciences building, providing flexible lab and office spaces. An innovation showcase will spotlight health tech companies The conference will conclude in a networking reception in Health Wildcatters offices.

To register for INVEST Digital Health, click here.

How Convenience Is Reshaping Clinical Strategy

Patients’ evolving preferences and expectations have forced health systems and digital health companies to rethink how care is delivered. This panel will dive into how providers are offering patients the level of consumer-centric convenience they’ve become accustomed to in other areas of their life — and how this shift can lead to improved loyalty, adherence and outcomes.

Hubert Zajicek, CEO Health Wildcatters (moderator)

Angeline Chen, Founding Director of Product, Novellia

Arpan Parikh, CEO, Kin Health

Travis Rush, CEO, Reperio Health

Adam Weinstein, Chief Product Officer, Teladoc

The Rise of Consumer Diagnostics

From gut health analysis to STI check-ups to whole-body biomarker testing, patients are increasingly turning to direct-to-consumer diagnostics platforms for answers about their health. In this session, healthcare experts in this space will talk about the level of personalization, clinical rigor and consumer engagement needed in order for people to navigate this type of personal health data.

Marissa Plescia, Reporter, MedCity News (moderator)

Leo Grady, CEO, Jona

Rachel Miller, PA, MBA, Head of Product & Growth, Labcorp

Kelly Lacob, CEO, Xella Health

Manish Arora, CEO, LinusBio

Pita Navarro, Chief Scientific Officer, Evvy

The New Age of Consumer Drug Platforms

Consumers want healthcare to work like retail, with transparent pricing, home delivery, intuitive digital experiences and on-demand access. In response, drugmakers are reshaping how patients access and purchase medications by launching direct-to-consumer platforms, which could bring pharma closer to the patient than ever before. How are consumer-facing models challenging traditional healthcare distribution channels? Can these new platforms improve affordability and adherence?

Shelley Bailey, Strategic Initiatives at the Independent Pharmacy Cooperative (IPC) (moderator)

Bethanie Baynes, Director of Payer Relations & Business Development, Amazon Pharmacy • Michelle Davey, CEO, Wheel

Thorsten Wirkes, Managing Director, Bertelsmann Healthcare Investments

Jessin Joseph, Vice President, PBA Markets, Judi Health

The Payer’s Role in the Consumer Health Era

As healthcare becomes more and more consumer-driven, how are payers fitting into the equation? From covering direct-to-consumer digital health tools to integrating members’ wearable data to deploying voice AI for navigation and member support, payers are being pushed to go beyond traditional benefit design.

Brian Whorley, CEO, Paytient (moderator)

Magda Lenartowicz, Chief Medical & Innovation Officer, Clever Care

Michelle Wang, Investor, Wavemaker 360

Erica Murdock, Managing Partner, Unseen Capital by Seae Ventures

Rosemary Gammon, Principal Consultant, CMR Healthcare Consultants

How Are Wearables Changing Health Behavior?

Listen to industry leaders discuss how they’re working to validate wearable data and integrate it into care delivery, as well as what they see coming down the pipeline in terms of reimbursement and regulatory pathways for wearable-driven care.

Ken Nelson, Partner, Nelson Jennings Ventures (moderator)

Tanvi Jayaraman, Clinical Lead for Health AI, ŌURA

Peter Micca, Managing Partner, Caduceus Capital Partners

Patrick Sheehan, VP of Value-Based Care, Withings

Ben Green, Chief Clinical Officer, AliveCor

When Consumer Brands Enter Employers’ Benefits Stack

The line between healthcare, consumer technology and employee benefits is blurring. More and more employers are partnering with consumer brands to deliver health services that feel more like retail experiences than traditional insurance offerings. Hear benefits leaders discuss how this trend is changing access and engagement.

Jack Stockert, Managing Director, Health2047 (moderator)

Ali Diab, CEO, Collective Health

Dana Lujan, CEO, Wellthlinks

Jason Tibbels, Chief Medical Officer, Lantern

Joanna Balogh-Reynolds, Senior Vice President of Strategic Partnerships, Progyny

Building the DTC Weight Loss Economy, One GLP-1 Script at a Time

GLP-1 drugs are one of the fastest-growing segments in digital health.This panel will explore how weight loss startups are structuring their businesses and engaging their patients to achieve health goals, as well as how they’re managing drug supply
constraints and evolving beyond prescriptions into complete metabolic health offerings.

Arundhati Parmar, Editor-in-Chief, MedCity News (moderator)

Adam Johnson, CSO, Twin Health

Alexander Fabry, SVP of Product, Noom

Laura Walmsley, Chief Commercial Officer, Virta Health

Wei-Li Shao, President & Incoming CEO, Omada Health

To register for INVEST Digital Health, click here.

Photo: kasto80, Getty Images

October 12, 2026
PBM Transparency Is Still Too Opaque — How Can Employers Rein In Drug Costs?

Healthcare premiums are expected to jump another 9% in 2027. The cost of care is reaching a point where some are forgoing health insurance entirely. Health plans and employers are looking for a cost-relief valve wherever they can.

Earlier this year, Congress moved to lower pharmaceutical costs, passing the Consolidated Appropriations Act of 2026 (CAA of 2026). The bill included pharmacy benefit management (PBM) reforms that would add greater transparency to the process these organizations use to price prescription medications. The legislation mandates that PBMs submit detailed semi-annual reports to employers about their rebate prices and overall spending. This has largely been celebrated as a major win for the healthcare industry. For employers, it’s a wait-and-see game, as its impacts won’t be felt until 2027.

Ahead of the CAA of 2026 and due to settlements with the Federal Trade Commission, PBMs are shifting how they manage their revenue. Some are telling their investors directly that, despite added regulation, they expect revenue to remain the same. PBMs are doing this by restructuring how revenue is captured and keeping it within their own ecosystem under a different label. This undercuts the transparency the legislation aimed to create—before it has even taken effect.

This means employers are trying to comparison shop in a market where all the price tags are hidden. And most can’t simply switch PBMs to find better pricing for their members. They face two structural challenges:

● Contractual hurdles: Most PBM contracts require lengthy notice periods for termination. Larger employers with custom contract terms often face notice requirements of up to 12 months. In practice, that means the decision to leave must be made before most employers have even begun evaluating alternatives. And leaving a contract early means an employer who received a rebate reconciliation payment or a performance bonus may be required to return it upon early termination, essentially penalizing them for exercising their right to change vendors. Rebate reconciliation timing creates an additional financial exposure. Most PBM contracts include a rebate reconciliation period of 12 to 18 months following contract termination, during which the PBM retains the right to adjust previously reported rebate figures.

● Data blockades: Upon termination of a PBM contract, employers are entitled to their claims data, but the timeline, format, and completeness of that data transfer are frequently governed by contract language that favors PBMs. Common tactics include:

○ Requiring expensive translation of proprietary data before a new PBM can intake it, potentially creating months-long implementation delays.

○ Charging data extraction fees that are not disclosed until termination is initiated, sometimes running into tens of thousands of dollars for larger plan populations.

○ Delaying the transfer of member eligibility files and prior authorization histories, which creates coverage gaps and member disruption at the moment of transition. For example, say a member is mid-therapy on a specialty drug with an active prior authorization; that authorization does not automatically transfer to the new PBM. The incoming PBM must re-adjudicate it, and during that window the member may face a coverage interruption.

Switching PBMs is inherently disruptive, time-consuming, and designed to create transition friction. However, there are times when finding a better-fit PBM outweighs the roadblocks. If that time comes, here are five key areas employers should consider to lower costs for their members:

● A strong foundation: Choose a PBM that employs rigorous clinical management, prior authorization, and formulary management practices. These are the primary mechanisms through which a PBM controls drug mix, ensures clinical appropriateness, and prevents unnecessary spend.

● Specialty drug management: This is often the highest-yield starting point. Strategies including specialty PBM carve-outs, site-of-care optimization, and alternative funding programs can reduce specialty spend by 25% to 40% in some categories, based on documented employer case results.

● GLP-1 management: Obesity-related GLP-1 clinical management programs that pair pharmacist coaching with behavioral support have shown reductions in ongoing GLP-1 utilization while preserving outcomes. Poorly structured programs may only shift costs rather than reducing them.

● Biosimilar-first policies: Employers should check their PBM contract for any biosimilar-first policies that may be in place for applicable drug categories. In many incumbent PBM formularies, branded biologics remain preferred due to rebate economics, even when a biosimilar is clinically equivalent and significantly less expensive.

● Transparency rules: Transparency requirements from the CAA of 2026 will compel greater fee disclosure, and employers who understand what those disclosures mean will be better positioned to act on them. The challenge is that most employers are not currently equipped to interpret what they see. That is where independent pharmacy advisors and employer-based coalition models can play a significant role.

While momentum is growing to enact more transparency across the healthcare industry and more specifically within the PBM space, the current disclosure rules still fall short of what employers need to lower costs. True transparency means employers can see every dollar that flows through their PBM: where it originates, who retains it, and on what basis. That means:

● Rebates are passed through in full and disclosed at the claim level

● A PBM’s specialty pharmacy is not receiving preferential routing that generates undisclosed margins

● Administrative fees are itemized and auditable

● Formulary decisions can be traced to clinical rationale rather than manufacturer economics

Healthcare continues to become more expensive, but employers don’t have to be passive participants. Even in an opaque PBM landscape, they can demand greater accountability and make more informed decisions that lower costs and improve care.

Photo: OsakaWayne Studios, Getty Images

Christine Johnston

With over 20 years of experience in the PBM space, Christine Johnston
is an accomplished pharmacy benefit leader and consultant with a demonstrated history of managing costs and improving processes for plan sponsors. She is the General Manager of MacroHealth‘s Pharmacy Solutions Marketplace and was previously the co-founder and president of Foundational Pharmacy Strategies, which was recently acquired by MacroHealth. Prior to that, Christine led a small pass-through PBM. Christine is dedicated to lowering the overall cost of care to ensure individuals do not face difficult trade-offs between essential needs and necessary medications.

This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.

October 7, 2026
FTC Sends Warning Letters to 24 Healthcare Organizations Over Price Transparency

The Federal Trade Commission sent warning letters to 24 of the “nation’s largest” healthcare services companies, citing concerns that they may be failing to provide transparent price information.

The letters were signed by FTC Chairman Andrew N. Ferguson. The agency did not disclose which organizations it sent the letters to.

It notes in the letter that Section 5 of the FTC Act requires these organizations to provide patients with “timely, accurate, and complete pricing for healthcare services, especially for non-emergency services that are scheduled in advance.” The agency urged the organizations to conduct a review of their pricing practices and make changes if they find they’re in violation of the FTC Act.

The letter also stated that price transparency is a major priority of the FTC across several sectors, including rental housing, hotels and grocery delivery services. Consumers can’t compare offerings and make informed decisions without price transparency, the letter said.

“Price transparency is particularly critical in the hospital and healthcare setting because healthcare is often one of the most significant and financially burdensome costs consumers face,” Ferguson wrote in the letter. “Patients frequently must invest substantial time and effort to travel for in‑person visits, making it even more important that they understand costs upfront before committing to care. Moreover, hospitals and healthcare facilities can charge dramatically different prices for the same services, leaving consumers vulnerable to wide and often unexpected cost discrepancies.”

CMS requires hospitals to publicly disclose pricing information for healthcare services through machine-readable files and consumer-friendly pricing information. They also must provide uninsured and self-pay patients with good-faith estimates of expected charges before scheduled care. However, the FTC stated that complying with CMS price transparency requirements doesn’t necessarily mean a healthcare provider is complying with the FTC Act, which may impose additional requirements.

The letter notes that the price of healthcare services is a “material term,” meaning “clear and conspicuous disclosures” are needed so consumers are not deceived.

“Accordingly, failing to disclose the price of a healthcare service may be deceptive if it is likely to mislead consumers acting reasonably under the circumstances,” Ferguson wrote. “Even when some price terms are disclosed, disclosures may be deceptive when they are incomplete — such as when they omit certain charges like physician fees or facility fees, or cover only a portion of the expected care — because consumers may reasonably believe they have been provided the total cost of care. Likewise, inaccurate disclosures mislead consumers and cause substantial harm.”

The FTC said the letters do not conclude that the recipients violated the FTC Act.

Photo: Oleksandr Hruts, Getty Images

October 6, 2026
Trump Administration Announces $90 Payments to Help Cover Medicare Part B Premiums

On Friday, President Donald Trump announced that the federal government is making one-time payments of $90 per person for more than 20 million people to help them pay for Medicare Part B premiums.

These payments are coming from the Medicare Improvement Fund, which is meant to make improvements to the Medicare fee-for-service program and has been given $2 billion by Congress. Eligible seniors will receive the payment via a direct deposit in early October.

According to a fact sheet, those whose premiums are paid by Medicaid or who pay an Income-Related Monthly Adjustment Amount don’t qualify for payments. Those enrolled in private Medicare Advantage plans also aren’t eligible.

This one-time payment likely won’t do much when it comes to offsetting rising healthcare costs, noted Juliette Cubanski, vice president and director of the Program on Medicare Policy at KFF, in a recent post.

Currently, Medicare’s standard Part B premium is $2,435 and is expected to increase by $79 annually for 2027, according to KFF. This means that “this increase alone would consume most of the $90 payment,” Cubanski noted. In addition, beneficiaries will likely see healthcare costs rise in other ways, such as deductibles and cost sharing for medical and drug benefits.

Cubanski also compared these $90 payments to a similar proposal announced by Trump ahead of the 2020 election, which involved a $200 drug card to offset out-of-pocket drug costs for Medicare beneficiaries.

“The cards were to be provided under a Section 402 demonstration designed to test whether lowering out-of-pocket drug costs would improve medication adherence, reduce unnecessary health care use, and lower Medicare spending,” Cubanski said. “Ultimately, the drug cards were never sent, amid questions about the design of the experiment and its nearly $8 billion projected cost.”

Cubanski noted that the $90 payments will mostly deplete the Medicare Improvement Fund.

These payments also come after the Trump administration announced in September $500 refunds per person to nearly 1 million Americans with Affordable Care Act coverage. One healthcare expert previously told MedCity News that these checks will do little to address healthcare affordability.

“There is no question that $500 matters to a family struggling to pay its bills, and Americans are struggling,” said Dr. Adam Brown, an emergency physician and founder of ABIG Health. “Healthcare costs are a significant part of that burden. But we have to put this refund into context. For someone paying the full cost of an ACA plan, $500 doesn’t even cover one month’s average premium. … Ultimately, we shouldn’t confuse a check with a healthcare affordability strategy.”

Photo: DBenitostock, Getty Images

October 5, 2026
Trump’s ACA Fraud Crackdown: Experts Urge Going After Bad Actors, Not Patients

Addressing fraud, waste and abuse in healthcare has been a major focus of the Trump Administration, particularly with the creation of the White House Task Force to Eliminate Fraud. Last week, the task force took a rather aggressive tactic, announcing that it will cancel 315,000 unauthorized enrollments covering more than 760,000 individuals in the Marketplace. The move, however, is being criticized by many in the medical industry.

The administration anticipates that this will return about $2.2 billion in taxpayer-funded subsidies.

“We are shutting down unauthorized Marketplace enrollments and returning approximately $2.2 billion in taxpayer-funded subsidies,” said HHS Secretary Robert F. Kennedy, Jr., in a statement. “CMS is strengthening safeguards, pursuing bad actors, and holding agents and brokers accountable when they break the rules. Under President Trump, HHS will protect Americans’ health coverage and ensure taxpayer dollars reach the people they are intended to serve.”

One healthcare expert argued that while there’s a need to address fraud in the Marketplace, patients shouldn’t be the ones punished.

“I agree we have to be going after bad actors, but we can’t be going after the patients,” said Dr. Adam Brown, an emergency physician and founder of ABIG Health.

Brown emphasized that these efforts can’t be looked at in isolation. The enhanced ACA premium tax credits expired at the end of 2025, increasing premiums for many Marketplace enrollees. In addition, the Trump administration is implementing Medicaid work requirements that states generally must begin by 2027.

“If you look at these things in isolation, you have a tendency to anchor to, ‘Well, that’s not a lot of people,’ or ‘I’m sure a lot of those individuals that are within that 760,000 number are not real individuals,’” Brown said. “But that all said, when you kind of look at all of these pieces of the puzzle, it makes me question: Are we trying to dismantle some of the important social service safety net type of programs in the country that so many people depend on, without a very clear alternative right now that’s affordable that gives them the necessary access?”

Brown urged CMS to establish a formal process for reinstating people who were wrongly disenrolled. He also called on Congress to extend the ACA tax credits.

Families USA, a patient advocacy organization, also spoke out against the decision.

“Once again, the Trump administration is using alleged fraud accusations as a political smokescreen to double down on what they are actually doing: taking health coverage away from hundreds of thousands of people,” said Anthony Wright, executive director of Families USA. “Real fraud should be stopped, especially dishonest brokers who sign people up without their knowledge. Previously, anti-fraud policies and procedures banned those brokers, but this administration reinstated them. Now families, not bad actors, are paying the price.”

This comes as recent research from the National Bureau of Economic Research found that the broader implementation of the ACA was associated with an estimated 20% to 30% reduction in mortality among people who were uninsured before the law.

With the administration’s decision to remove 760,000 people from ACA coverage, it’s important to note that not all of those people will become uninsured, noted one of the paper’s authors, Robert Kaestner, research associate at the University of Chicago.

“The majority of them are going to have access to other types of health insurance… So 250,000 people who might end up uninsured out of a country of 333 million — that’s not a big change, but still, it’s 250,000 people potentially without health insurance. That’s a very serious consequence,” Kaestner estimated.

Photo: illustration, Getty Images

October 4, 2026