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The Employer Retirement Income Security Act (ERISA) is a federal law that, among other functions, sets minimum standards for employer-sponsored health plans. States have recently passed laws that attempt to regulate pharmacy benefit managers (PBMs), and ERISA has been used to preempt these, which has been a focus for all sponsors of group health plans and a worry for states.
While the U.S. government could theoretically buy drug patents to lower costs, current and more realistic tools include march-in rights, Section 1498, and government-negotiated licensing. These mechanisms can force lower prices or enable cheaper generic versions of expensive medications. In this blog, we’ll break down how these policies work, their potential impact on drug affordability in the U.S., and what they could mean for patients facing rising prescription costs.
One of the tools states are considering implementing is Prescription Drug Affordability Boards (PDAB) that offer upper payment limit (UPL) authority. Only some states have PDABs, and none have yet fully implemented UPLs, but they are on their way to doing so. Can this help drug pricing? Learn more about these programs.
As of March 2025, there were 270 medications in active shortage status in the United States. Many of these medications had also been scarce for months or years before that, which has left healthcare providers scrambling.
For decades, hospitals and other eligible entities have been able to purchase outpatient medications at significantly lower rates directly from pharmaceutical companies via the 340B program. This made it possible for facilities and providers to offer care to uninsured and underinsured populations.
The Eliminating Thickets to Increase Competition (ETHIC) Act would help limit the number of drug patents that can be asserted by those who hold the patents, including drug companies. This bill would make room for more competition, helping lower prescription medication costs while not stifling innovation.
As medication prices continue to escalate, three drugs are going generic. They are Entresto, Tradjenta, and Opsumit. Despite the court battles that have ensued, the generic options will be available to patients soon. Learn more about the path that has led to the availability of these generic medications.
A recent survey that the Business Group on Health conducted revealed that employers across the nation expect to see health care costs increase by 9% in 2026. But what is leading to this significant hike in costs? Here’s what you should know about the trends that could cause such an increase for employers and even more for individual payers.
Although it provides significant cost relief for beneficiaries, the Inflation Reduction Act (IRA) is designed to reduce government spending on prescription drugs by restructuring Medicare Part D liability. Passed by the Biden administration in 2022, the law’s primary goals are to lower out-of-pocket costs for enrollees and enable Medicare to negotiate prices.
Health care spending has increased significantly nationwide in the past few years, and several key factors are behind this surge in costs. By understanding the top 10 trends shaping this spending, you can better understand what to expect from the industry in the coming years.
