A pharmacy benefit manager (PBM) without all the usual drama? It’s a lofty goal.

Federal lawsuits and investigations have accused the three largest PBMs—CVS Health’s Caremark, Cigna Evernorth’s Express Scripts, and UnitedHealth Group’s Optum Rx—of overcharging for drugs, pocketing savings, and giving perks to their vertically integrated insurance companies as well as their own specialty and mail order pharmacies.

The Big 3 deny this, saying they pass the vast majority of savings on to customers. They’ve recently introduced some transparent models to prove it. Cigna’s Express Scripts, for instance, announced Oct. 27 it would phase in up-front discounts to replace rebates.

Meanwhile, alternative PBMs that already have transparent models like AffirmedRx, Rightway Healthcare, and Navitus Health Solutions are gaining traction. Experts tell Healthcare Brew that though these alternatives aren’t perfect, their models may save insurers and patients money.

“Everybody in the [traditional] supply chain benefits from higher list prices,” Navitus SVP and Chief Pharmacy Officer Sharon Faust told Healthcare Brew. “It requires innovation and disruption of all the historical models to drive cost savings.”

This alt PBM is trying to shake things up.—MA, CC

Welcome back to AI 411, a monthly roundup of AI announcements from across the healthcare industry.

October was a big month for health tech and it was the star of the show at the 2025 HLTH conference in Las Vegas, which not only had a designated AI area but also many conversations about emerging technologies.

Here’s your breakdown of October health-related AI updates from across the industry.

Alignmt AI. AI governance and risk management company Alignmt AI announced Oct. 1 a collaboration with the MSK Innovation Hub at Memorial Sloan Kettering Cancer Center, a cancer institution in New York, to help enhance its oncology AI governance.

American Medical Association (AMA). On Oct. 20, the AMA launched a Center for Digital Health and AI, a new initiative meant to incorporate doctors into “shaping, guiding, and implementing technologies transforming medicine,” according to a press release. It covers how AI impacts everything from policy to clinical workflow to education.

See the full list here.—CM

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Electronic health records (EHR) giant Epic Systems has largely become a mainstay to many hospital providers, with last year being its biggest year yet as it added 176 multispecialty hospitals and more than 29,000 beds to its market, Fierce Healthcare reported in May. That jump in growth brought the company to control 42.3% of the acute care EHR market.

So it only makes sense that there would be hospital employees whose entire job is to navigate Epic.

That’s where Sacramento, California-based UC Davis Health’s Kevin Fox, certified Epic systems telehealth analyst, comes in. He works to help coordinate virtual care for the 653-bed facility, and previously did similar work as an Epic analyst with Fresno, California-based Community Medical Centers and Newton, Massachusetts-based Atrium Health.

Healthcare Brew spoke with Fox about how his role works and the areas he’s most excited about in the industry.

Find the full conversation here.—NO