Payers

Amelia Kinsinger

Pharmacy benefit managers (PBMs) have taken a number of steps recently to make their practices more transparent, such as eliminating rebates or shaking up pricing models.

The moves follow intense public scrutiny over evidence that PBMs’ outsized—and opaque—influence in the pharmaceutical supply chain may play a large role in keeping drugs unaffordable for many Americans.

But experts told Healthcare Brew it’s unclear whether such changes will lead to any substantial improvements in drug affordability anytime soon.

PBMs are often called “middlemen” because they operate between drug manufacturers and health insurance plans. They negotiate with the manufacturers to create formularies, or lists of drugs that insurers agree to cover. They also help health plans adjudicate prescription claims, reimburse pharmacies for dispensed prescriptions, and decide which pharmacies are in network for a specific plan.

Learn more about the push for PBM transparency here.—MA

      

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Healthcare leaders are increasingly counting on AI to help streamline their day-to-day workflows. From assisting clinicians to alleviating administrative burdens, AI helps healthcare professionals get back to what they do best: patient care.

The Comcast Business Healthcare Tech Trends Report for 2026 and Beyond found that 88% of healthcare leaders already trust and utilize AI to assist in both clinical and operational workflows.

AI isn’t just making an impact on the clinicians’ side—patients are leveraging it, too. The report cites that 39% of younger adults now trust generative AI to help evaluate their symptoms.

Curious about how AI is transforming the future of healthcare? Get the scoop in the full report from Comcast Business.

Direct Care

Village of Healing

Color Health, a virtual cancer clinic partnering with employers and health plans, is now offering at-home tests for the human papillomavirus (HPV).

The announcement comes ahead of a federal mandate set to take effect next year that will require most private insurance plans to cover at-home HPV screening. The Food and Drug Administration approved several at-home HPV tests in 2024 and 2025.

“Having at-home options for patients is important because it removes a lot of barriers that typically prevent patients from doing what they need to do,” Dany Matar, COO of Color Health, told HR Brew.

A recent paper published in BMC Public Health shows most patients are open to using HPV self-collection tests, and in many cases prefer it. The study, which drew upon a survey of 359 women presenting to emergency departments, found 84% were willing or very willing to use an HPV self-sampling kit if they were offered one, and 58% preferred this option to having a physician or nurse perform it.

Keep reading on HR Brew.—CV

      

Hospitals & Facilities

Illustration: Anna Kim, Photos: Adobe Stock

Hospitals are quietly financing the nation’s overdose response—but it doesn’t have to be this way.

Federal policy guarantees payment for emergency and inpatient care, including emergency post-overdose treatment, yet public health prevention infrastructure still depends on short-term grants that can disappear overnight. When the Department of Health and Human Services (HHS) abruptly terminated and then reinstated $1.9 billion in addiction and mental health funding this January, it did more than create administrative confusion. Letters sent to 2,000+ providers alleged non-alignment with Substance Abuse and Mental Health Services Administration (SAMHSA) priorities and instructed programs to begin winding down services.

Chaos ensued. Outrage erupted almost instantly.

The prompt reversal prevented immediate collapse, but it also exposed a deeper structural problem: Prevention remains subject to annual appropriations and administrative shifts, and largely relies on Medicare and Medicaid dollars. Medicaid alone spends an estimated $29 billion annually on opioid use disorder treatment and pays for nearly half of opioid-related emergency department visits, according to a recent Brookings Institution report. In short, crisis care (i.e., life-saving treatment during an overdose) is guaranteed. Prevention—which includes naloxone distribution, medication initiation, peer recovery follow-up, and post-overdose outreach—is not.

The Trump administration’s inaction to stabilize funding for prevention continues to leave hospitals shouldering billions in avoidable medical expenses. It’s time for the industry to demand an end to this.

Keep reading the op-ed, originally published in March, here.—CLD

vital signs

Francis Scialabba

Today’s top healthcare reads.

Stat: 2.4%. That’s how much Medicare reimbursements to skilled nursing facilities will increase in fiscal 2027. (CMS)

Quote: “What that tells me is that there are patients who are completely unable to pay. We’re really crushing people who are desperately trying to pay their bills.”—Laura Kaiser, CEO of nonprofit hospital group SSM Health, on the rise of uninsured patients as a result of Medicaid cuts (the New York Times)

Read: How local pediatricians are skirting the Trump administration’s vaccine advice. (NPR)

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