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5 Questions to Ask Your PBM Before Signing

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We recently covered the key components of a PBM contract, but it goes further than words on a page. The discounts, rebates, and projected savings only account for part of the story. In order to find true alignment with your next PBM partner, the following five questions can help shape the tough conversations plan sponsors across the country are having this time of year. 

Starting off strong…

1. How Do You Make Money?

This quickly gets to the root of it all: What drives the PBM’s revenue?

Depending on the model, traditional PBMs can generate revenue in a variety of ways, including hidden fees, spread pricing, rebate retention, and pharmacy arrangements. Given the options available in the marketplace, employers should understand exactly how their PBM is compensated.

A transparent discussion about revenue sources can help organizations identify potential conflicts of interest and better understand the incentives that may influence decision-making. The goal isn't necessarily to find a PBM that makes the least amount of money. Rather, it's to ensure that compensation is clearly disclosed and that both parties understand how value is being created within the relationship.

2. If Discounts or Rebates Improve During the Contract Term, Do We Benefit?

The pharmacy marketplace changes constantly. Drug prices fluctuate, manufacturer rebate programs evolve, and pharmacy network contracts are regularly renegotiated.

When improvements occur, plan sponsors should understand whether those savings flow through to the plan or remain with the PBM. Some contracts lock financial guarantees at the outset of the agreement, while others allow employers to benefit from favorable market changes as they occur.

Asking this question helps determine whether the PBM's success is tied to the client's success. It can also uncover opportunities for greater transparency regarding how pricing improvements are tracked, reported, and shared throughout the contract term.

3. Are You Willing to Offer a One-Year Contract?

Contract length may seem like a minor detail, but it can reveal a great deal about a PBM's confidence in its ability to deliver results.

Multi-year agreements are common throughout the industry and can provide stability for both parties. However, shorter contract terms may offer employers greater flexibility to reassess performance, respond to changing business needs, or evaluate alternative solutions.

If a PBM is reluctant to consider a shorter agreement, it may be worth exploring the reasons why. Employers should understand any renewal provisions, termination clauses, and performance-based protections available within the contract. The objective is to create a relationship built on ongoing value rather than contractual obligation.

4. Do You Offer a Net Cost Savings Guarantee?

Discount guarantees and rebate guarantees can be a helpful tool when making a big decision like switching PBM vendors, acting as a safety net to protect your resources. 

A net cost savings guarantee, like those often offered by MedOne, focuses on the overall financial outcome rather than individual pricing components. This broader perspective can help plan sponsors evaluate whether the benefit is delivering meaningful value after all costs, fees, and rebates are considered.

By discussing net cost performance, employers can shift the conversation away from isolated metrics and toward the results that matter most: controlling pharmacy spend while maintaining appropriate access to medications for members.

5. Do You Pass Through 100% of Manufacturer Rebates?

Manufacturer rebates continue to play a significant role in pharmacy benefit economics, making rebate transparency a critical contract consideration.

When evaluating rebate arrangements, employers should seek clarity on what percentage of rebates are returned, how rebates are calculated, and whether any administrative offsets or exclusions apply. Some arrangements provide full rebate pass-through, while others allow a PBM to retain a portion of rebate revenue as part of its compensation model.

Understanding how rebates are managed helps employers make more informed comparisons between competing proposals and better evaluate the true financial impact of each arrangement.

Looking Beyond the Proposal

The best PBM relationships are built on more than pricing guarantees and contract language. They are grounded in trust, transparency, and a shared commitment to achieving better outcomes for both the plan and its members.

By asking strategic, intentional questions early in the evaluation process, employers can gain a clearer picture of how a PBM operates, what drives its business decisions, and whether its approach aligns with the organization's long-term goals. In an increasingly complex pharmacy landscape, these conversations can help transform a standard vendor selection process into a strategic partnership that delivers lasting value. 

5 Key Components of a PBM Contract | MedOne News | MedOne - Pharmacy Benefit Solutions
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5 Key Components of a PBM Contract

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A PBM contract serves as the foundation of your pharmacy benefit program, defining everything from pricing guarantees and rebate arrangements to clinical management and reporting expectations. Yet many employers sign agreements without fully understanding the contract language that governs how their pharmacy benefit is administered. Taking a closer look at these key provisions can help organizations better evaluate PBM proposals and protect the financial interests of their health plan.

Whether you're evaluating a new PBM partner or preparing for a contract renewal, understanding the fundamentals can help you make more informed decisions and avoid costly surprises down the road. The information below summarizes several key concepts every plan sponsor should understand when reviewing a PBM contract.

Traditional vs. Pass-Through PBM Contracts

When evaluating PBM partners, one of the first considerations is understanding the type of contract being offered.

Traditional PBM Contracts: Traditional PBM arrangements often generate revenue through spread pricing, which is the difference between what the PBM pays a pharmacy and what the PBM charges the plan sponsor for the same claim. Administrative fees are typically not collected separately because PBM compensation is built into the pricing structure.

Potential advantages may include:

  • Simpler fee structure from the employer's perspective

  • Lower visible administrative fees

  • Established pricing models commonly used throughout the market

Important contract considerations include:

  • How spread pricing is defined

  • Rebate retention practices

  • Audit rights

  • Performance guarantees

  • Financial reconciliation processes

Pass-Through PBM Contracts: Pass-through arrangements generally provide greater transparency by passing through pharmacy costs, manufacturer rebates, and other negotiated savings directly to the plan sponsor. In exchange, the PBM receives an administrative fee that is typically disclosed upfront.

Potential advantages may include:

  • Greater pricing transparency

  • Clearer understanding of PBM compensation

  • Increased flexibility for formulary and utilization management strategies

Important contract considerations include:

  • Administrative fee structure

  • Rebate pass-through methodology

  • Reporting transparency

  • Audit provisions

  • Performance guarantees and reconciliation processes 

When selecting a model, the key is ensuring the agreement clearly defines how the PBM is compensated and how performance will be measured.

Five Areas of Every PBM Contract You Should Review

While every agreement is unique, five contract areas deserve special attention.

1. Definitions

Definitions form the foundation of the contract. Terms as simple as "brand drug," "generic drug," "specialty drug," "rebate," and "average wholesale price (AWP)" can have substantial financial implications.

Even seemingly straightforward terms can be defined differently across PBMs. Ambiguous language may create opportunities for interpretation that affect guarantees, pricing calculations, and reporting outcomes.

When possible, plan sponsors should look for definitions that rely on established industry references and independent third-party benchmarks rather than subjective PBM discretion.

2. Financial Guarantees

Competitive pricing is important, but guarantees are what hold pricing promises accountable.

Strong financial guarantees help provide:

  • Budget predictability

  • Cost management 

  • Transparency

  • Accountability if pricing benchmarks are not achieved

Contracts should clearly explain what happens if guarantees are missed and how any financial shortfalls will be reconciled. Plan sponsors should also pay close attention to the circumstances under which pricing guarantees can be modified mid-contract.

3. Exclusions

Not all drugs may be included in contractual pricing guarantees.

Certain categories can be excluded from reconciliation calculations, including:

  • Over-the-counter products

  • Vaccines

  • 340B-eligible drugs

  • Compound medications

  • Limited distribution drugs (LDDs)

These exclusions can materially impact reported savings and guarantee performance. Understanding what's included and excluded is critical when comparing PBM proposals.

4. Performance Guarantees

Performance guarantees extend beyond financial terms. They measure whether a PBM is delivering on promised services and outcomes.

Examples may include:

  • Claims processing accuracy

  • Customer service standards

  • Call center responsiveness

  • Clinical program effectiveness

  • Reporting timeliness

Employers should seek guarantees that are measured at the client level rather than broad book-of-business targets, ensuring accountability reflects the performance of their specific plan.

5. Reconciliation and Audit Rights

Even the strongest guarantees provide little value if they cannot be verified.

Contracts should include clearly defined audit rights and reconciliation procedures that allow plan sponsors to validate:

  • Pricing guarantees

  • Rebate payments

  • Network discounts

  • Administrative fees

  • Performance metrics

An effective auditing process helps ensure transparency and confirms contractual commitments are being fulfilled.

Going Beyond the Contract

Your PBM should be a true partner; someone you can trust to come alongside your organization to help manage costs, improve member outcomes, and navigate an increasingly complex pharmacy landscape. While pricing is certainly an important consideration, contract terms tell only part of the story. Employers should also evaluate the strength of the relationship, the quality of service provided to both administrators and members, the PBM's approach to clinical programs and utilization management, the depth and transparency of reporting, and the overall flexibility of the contract structure. Taken together, these factors provide a more complete picture of whether a PBM is equipped to support your organization's long-term goals.

PBM contracts are complex, but they don't have to be confusing. By focusing on definitions, financial guarantees, exclusions, performance standards, and audit rights, plan sponsors can better understand what they're purchasing and how success will be measured. 

Most importantly, employers should ask questions, seek clarification when language seems unclear, and work closely with trusted advisors and legal counsel during the review process.

The most effective PBM contracts are often the simplest: clearly written, transparent in intent, and aligned with the goals of both the plan sponsor and the PBM partner. A partnership built on transparency, clear communication, accountability, and a shared commitment to helping members access affordable medications is your path forward. 

Understanding GLP-1 Therapies | MedOne News | MedOne - Pharmacy Benefit Solutions
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Understanding GLP-1 Therapies

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What Sets GLP-1 Therapies Apart

GLP-1 medications have quickly become one of the most talked about topics in healthcare. Whether the conversation is about Type 2 Diabetes management, obesity treatment, cardiovascular health, or pharmacy benefit costs, GLP-1 therapies continue to dominate headlines and benefits discussions alike.

For both brokers and plan sponsors, understanding the differences between these medications has become increasingly important. While GLP-1s are often grouped together, different therapies vary significantly in how they work, the conditions they treat, their effectiveness, dosing schedules, and overall impact on healthcare costs.

Not all GLP-1s are the same. Understanding those differences can help better inform both clinical and benefit decisions.

What is a GLP-1?

GLP-1 stands for glucagon-like peptide-1, a naturally occurring hormone released in the gut after eating. This hormone plays an important role in regulating blood sugar levels, slowing digestion, and signaling fullness to the brain.

GLP-1 receptor agonists are medications designed to mimic these natural processes in the body. By helping patients feel fuller longer and improving how the body regulates glucose, these therapies have become widely used in the treatment of Type 2 Diabetes and Obesity.

Over the last several years, researchers have also discovered additional benefits associated with certain GLP-1 therapies, including cardiovascular risk reduction, chronic kidney disease management, and other emerging indications.

As the market continues to evolve and new medications enter development, it's helpful to understand how today's available therapies compare to what's ahead. 

The History of GLP-1 Therapies

GLP-1 medications first entered the market in 2005 when the U.S. Food and Drug Administration approved Byetta® (exenatide) for the treatment of Type 2 Diabetes.

While groundbreaking at the time, Byetta's twice-daily injection schedule eventually became less attractive as newer medications offered more convenient dosing options and improved health outcomes. As a result, Byetta was discontinued in 2024.

Since then, pharmaceutical manufacturers have continued advancing the science behind GLP-1 therapies, leading to medications that are more effective, longer lasting, and capable of treating multiple health conditions.

Today, two therapies dominate much of the conversation: semaglutide and tirzepatide.

Semaglutide

Brands: Ozempic®, Wegovy®, (formerly) Rybelsus®

Semaglutide is currently one of the most widely prescribed GLP-1 therapies on the market.

Its strong binding to the GLP-1 receptor allows it to remain active in the body longer than earlier generations of GLP-1 medications. This extended action supports once-weekly dosing for injectable products and has contributed to its widespread adoption.

Semaglutide is approved for several indications, including:

  • Type 2 Diabetes management (Ozempic injections and tablets)

  • Weight management (Wegovy)

  • Cardiovascular risk reduction in certain populations (all formulations)

  • Chronic kidney disease in qualifying patients (Ozempic injection)

Depending on the product, semaglutide may be administered as a weekly injection or, as of January 2026, as an oral tablet. The availability of both injectable and oral formulations has helped broaden accessibility of this GLP-1 treatment.

Tirzepatide

Brands: Mounjaro®, Zepbound®

Although often discussed alongside GLP-1 therapies, tirzepatide has a slightly different mechanism of action. 

Tirzepatide is a dual GIP/GLP-1 receptor agonist, meaning it activates two metabolic pathways rather than one. The addition of GIP activity appears to enhance the medication's metabolic effects and has contributed to the significant weight-loss outcomes observed in clinical studies.

Today, tirzepatide is approved for:

  • Type 2 Diabetes management (Mounjaro)

  • Weight management (Zepbound)

  • Moderate-to-severe obstructive sleep apnea in adults with obesity (Zepbound)

Looking Ahead: What's Next in the GLP-1 Pipeline?

The future of obesity and diabetes treatment may extend well beyond traditional GLP-1 medications. Several therapies currently under investigation are attempting to build upon the success of semaglutide and tirzepatide through new mechanisms of action.

While these medications remain in clinical development and have not received FDA approval for widespread use, they provide insight into where the market may be headed.

Retatrutide

Retatrutide is a triple-agonist medication that targets GLP-1, GIP, and glucagon receptors simultaneously. By activating three metabolic pathways at once, researchers hope to further improve weight loss and metabolic outcomes. Early clinical data has generated significant interest because of the magnitude of weight-loss results observed during trials. 

If approved, retatrutide could represent one of the next major developments in obesity treatment.

Maridebart Cafraglutide

Brands: MariTide

MariTide combines GLP-1 activity with a GIP receptor antagonist approach.

Unlike tirzepatide, which activates the GIP receptor, MariTide blocks GIP signaling. Researchers are studying whether this different mechanism can produce meaningful weight reduction while allowing for less frequent administration.

One of its most notable characteristics is its potential once-monthly dosing schedule, which could improve convenience and adherence for many patients.

Amycretin

Amycretin pairs GLP-1 activity with amylin receptor agonism.

Amylin is another hormone involved in appetite regulation and satiety. By targeting both pathways, researchers hope to create deeper appetite suppression and enhanced weight-loss effects compared to traditional GLP-1 therapies alone.

This dual approach has made Amycretin one of the more closely watched medications currently in development. 

Survodutide

Brands: Xultophy®, Soliqua 

Survodutide combines GLP-1 receptor activity with glucagon receptor agonism.

While the medication is being studied for weight management, researchers are also evaluating its potential role in addressing liver-related metabolic conditions, including metabolic dysfunction-associated steatohepatitis (MASH, formerly NASH).

Its potential ability to impact both weight loss and liver health makes it a unique candidate within the development pipeline.

Cagrilintide

Brands: CagriSema (cagrilintide + semaglutide)

Cagrilintide, an amylin receptor agonist, both independently and in combination with semaglutide through a product known as CagriSema.This approach is designed to target two key pathways: appetite regulation and effective management of blood glucose levels. 

GLP-1 therapies continue to shape pharmacy benefit conversations across the country. As new products enter the market and existing therapies gain popularity and notch additional indications, employers face increasingly complex decisions regarding coverage strategy, utilization management, and long-term affordability.

Some organizations prioritize broad access. Others focus on outcomes-based criteria or targeted coverage approaches. Just as your benefit strategy is unique to your organization, so too should your GLP-1 strategy. 

Understanding the differences between today's therapies and tomorrow's GLP-1 pipeline is an important first step in building a pharmacy benefit strategy that aligns with both member health goals and plan sustainability. As pharmacy benefit managers continue evaluating their approach to GLP-1 coverage, understanding those distinctions will become increasingly important in the years ahead.

More Control, Faster Access: New myMedOne Features Make Managing Prescriptions Easier | MedOne News | MedOne - Pharmacy Benefit Solutions
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More Control, Faster Access: New myMedOne Features Make Managing Prescriptions Easier

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The goal of the myMedOne Member Portal is to ensure members have access to their prescription benefit information anytime, anywhere. In an effort to enhance this experience, we’ve introduced several enhancements, outlined below, to myMedOne that make it easier for members to manage their medications, access their account(s), and stay informed about important refill decisions. 

Faster, More Secure Sign-In with Passkeys

Regarding access to myMedOne account, we’ve introduced passkey features. Passkeys are a more secure and convenient alternative to a traditional password that members then have to remember and/or store. Passkeys use the security features already built into a member's device, including Face ID, fingerprint recognition, or a device PIN, to verify identity. 

Once a passkey is added, members can sign in quickly without needing to remember or enter a password. The result is a simpler sign-in experience that maintains strong account security while reducing login time and frustration.

A Quicker Sign-In Experience with "Remember Me"

For members who access myMedOne regularly, we've added a "Remember Me" option during sign-in. When selected on a trusted personal device, myMedOne can remember the member's username, making future logins faster and reducing the need to repeatedly enter account information.

When combined with passkey authentication, members can access their account with fewer steps while maintaining a secure experience.

Cancel an MPS Refill Directly from myMedOne

Medication needs can change over time. A member may have medication remaining on hand, be transitioning to a different therapy, or simply no longer need a scheduled refill.

With this enhancement, eligible high-cost mail order refills at MedOne Pharmacy Services (MPS) can be canceled directly through myMedOne without requiring a phone call to the pharmacy. If a member chooses to cancel a refill in myMedOne, the request is removed from the pharmacy queue and will not be processed or shipped. Members who prefer to work directly with the pharmacy can still do so, and any action taken by the pharmacy will automatically update the refill status within myMedOne.

More Control Over High-Cost Mail Order Refills

For certain high-cost medications filled through MedOne Pharmacy Services (MPS), members can now review refill requests directly in myMedOne before the medication is processed and shipped.

When a refill is ready for review, members who have opted in to mail order notifications will receive a text message, an email, or both. The notification will direct them to the alert on the Mail Order page, identifying the medication that requires their attention.

Members can then choose to: A) Approve the refill so processing and shipping can move forward, or B) Cancel the refill if desired. 

Once a decision is made, the pharmacy is updated automatically. Approved refills continue through the fulfillment process, while canceled refills are removed from the pharmacy queue.

This additional step helps ensure medications are shipped only when they're needed while giving members greater visibility and control over their prescription therapy. 

Add myMedOne to Your Home Screen

myMedOne is now a Progressive Web App (PWA), allowing members to add the portal directly to their phone's home screen without downloading an app from an app store.

Once installed, members can launch myMedOne directly from their device and enjoy a more app-like experience, including:

  • One-tap access from the home screen
  • A streamlined, full-screen mobile experience
  • Faster sign-in with Passkey support
  • Easy access to prescription and benefit information

Members with a myMedOne account will receive a notification, alerting them that this feature is available. Installation can also be completed later through the Manage My Account section of the portal.

These enhancements are part of our ongoing commitment to making pharmacy benefits easier to navigate and manage.

Whether it's reviewing a high-cost refill, canceling a medication that is no longer needed, or signing in with a passkey, each update is designed to give members greater convenience, visibility, and control.

At MedOne, we're continually looking for practical ways to improve the member experience, and these enhancements are another step toward making prescription management simpler and more accessible for the people we serve.

Top 5 Reasons to Move to MedOne | MedOne News | MedOne - Pharmacy Benefit Solutions
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Top 5 Reasons to Move to MedOne

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Choosing a pharmacy benefit manager (PBM) is one of the most important decisions an employer can make. The right partner can help control costs, improve member health, and provide the transparency needed to make confident decisions. The wrong partner can leave you wondering where the money went and whether members are getting the support they need.

At MedOne, we've built our model differently. We believe plan sponsors deserve visibility into their pharmacy benefit, members deserve personalized care, and every decision should be aligned with the client's best interests.

Employers and brokers evaluating pharmacy benefits today often compare MedOne against organizations like EmpiRx, MedImpact, Navitus, RxBenefits, and SmithRx, as well as the Big 3 (Express Scripts, CVS Caremark, and Optum Rx). While each PBM operates differently, MedOne continues to stand apart through its transparent pass-through model, clinical oversight, personalized service, and consultative approach.

Here are five reasons self-funded employer groups, plan sponsors, consultants, and brokers should choose MedOne as their Pharmacy Benefit Manager. Whether you're looking for a PBM for employers or a PBM for brokers seeking greater transparency and alignment, MedOne was built to deliver a different experience.

1.  Full Transparency and Complete Alignment

We’d be remiss to not first focus on our founding story. MedOne was founded in 1999 by a pharmacist and business owner, who saw a sweeping lack of transparency in the marketplace. Fast-forward, the market isn’t much clearer. But MedOne’s approach is: Provide a fully transparent, 100% pass-through pharmacy benefit to plan sponsors looking to do things differently. More than 25 years later, that commitment to being a transparent PBM remains at the center of everything we do. For employers searching for transparency in pharmacy benefits, understanding where every dollar is going is no longer a nice-to-have. It's a need-to-have.

This concept of transparency, especially of late, is the reason many employers start exploring a PBM change in the first place. Traditional PBM contracts can be difficult to navigate, often leaving employers with questions about rebates, fees, pricing methodologies, and where savings are ultimately flowing.

At MedOne, our model is much simpler: We operate as a pass-through PBM with a fully transparent pricing model. Whether savings come from rebates, discounts, manufacturer programs, or other pharmacy-related opportunities, employers know exactly where those dollars are going. Our incentives are aligned with our clients' incentives. When we identify savings opportunities, those savings belong to the plan sponsor, not us.

For employers evaluating alternatives to large national PBMs (Express Scripts, CVS Caremark, and Optum Rx), transparency is often one of the first areas they examine. Understanding exactly how the PBM is compensated and where savings are flowing can have a significant impact on benefit strategy and long-term plan performance.

2. Clinical Programs That Go Beyond Cost Management

Controlling pharmacy spend matters, but not at the expense of member health. That's why our Clinical Care Paths focus on both outcomes and cost management. Rather than applying broad utilization management programs that treat every member the same, we build targeted clinical pathways around specific disease states, medication classes, and treatment opportunities.

Our Clinical Care Paths are organized into four categories, allowing employers to align clinical oversight with their goals and member population:

  • Core Care Paths focus on foundational cost and utilization management opportunities that drive value across the plan.
  • Premium Care Paths build on that foundation with additional management strategies aimed at optimizing appropriate medication use and reducing unnecessary spend.
  • Enhanced Care Paths address more complex clinical scenarios and emerging opportunities where additional oversight can improve outcomes and plan performance.
  • Specialty Care Paths focus on some of the highest-cost medications and conditions, helping ensure members receive clinically appropriate therapy while identifying opportunities to manage specialty spend responsibly. 

Unlike many traditional PBM models, our Clinical Care Paths are designed to give employers greater control over how clinical strategies are applied, helping align pharmacy benefits with organizational goals, member needs, and overall cost-management priorities. 

From biosimilars and specialty medications to chronic condition management and emerging therapies, our clinical team continuously evaluates opportunities to help members access the right medication at the right time at the best cost. The result is a more thoughtful approach to pharmacy benefit management that supports better health outcomes while helping plan sponsors avoid unnecessary spending. 

3. Real Conversations with Real People

Many PBMs talk about member experience as a buzzword, but at MedOne, it's the foundation of our service model.

When members have questions about their medications, benefits, alternatives, or prior authorizations, they aren't routed through endless prompts or call center layers hoping to reach someone who can help. At MedOne, members can get a hold of a real person, right here in the United States, in just under 40 seconds. We believe that this is crucially important to the overall member experience.

Sometimes that conversation helps a member understand their coverage options. Sometimes it uncovers a lower-cost therapy. Sometimes it simply gives someone peace of mind about a medication they're taking.

If that member has a more clinically involved question or concern, we can route them to an on-staff clinical pharmacist who can provide personalized guidance and answer their questions one-on-one.

Whatever the situation, we believe pharmacy benefits should feel personal.

Healthcare can be complicated enough without getting the runaround on the phone regarding your prescription coverage.

4. Reporting That Helps You Make Better Decisions

For brokers and employers alike, access to clear and actionable reporting is essential when evaluating plan performance and making informed benefit decisions. Data is only valuable if it's easy to access and easy to understand.

Our dynamic reporting platform provides access to meaningful plan performance information and customized analytics that help clients understand what's happening within their plan.

Specialty spend trends, therapeutic categories, utilization patterns, top cost drivers, savings initiatives, and member engagement metrics, are all key talking points when our clients meet with their designated account management team. Because the other half of this the analysis. Accessing your plan performance data should be a given. 

MedOne couples that access with personalized plan recommendations and consulting based on your unique benefit philosophy and member populations. There is certainly no one-size-fits-all when building a benefit, and that concept is mirrored in your reporting and plan review. 

5. Our Ability to Adapt & Evolve 

One of the biggest frustrations employers face is being told there is only one way to structure their pharmacy benefit. As previously stated, every organization has different priorities, different budgets, different populations, and different goals. These are all factors taken into account when building a pharmacy benefit with MedOne. That's why employers and brokers who are evaluating alternatives to traditional PBM models, like the Big 3, or even other transparent PBMs, often look for a partner that can adapt as their needs evolve.

Some employers and/or plan sponsors are focused on specialty drug management. Others are trying to navigate GLP-1 coverage decisions. Some want aggressive cost containment. Others prioritize member disruption and access.

At MedOne, we work with clients to build a pharmacy benefit strategy that aligns with what they're trying to accomplish, rather than forcing them to choose Plan A, B, or C. Whether the focus is specialty drug management, GLP-1 strategy, member access, or cost containment, the benefit should reflect the goals of the group, not the limitations of the PBM. This approach allows employers to make decisions based on what's right for their members and their organization. And that's exactly how it should be.

Couple this approach with an ever-changing marketplace (think direct-to-consumer programs, new-to-market medications, shifting federal and state legislations, etc) and your PBM partner is key, now more than ever. And it’s clear: Your PBM partner should be MedOne Pharmacy Benefit Solutions. 

Employers and brokers evaluating PBM options have more choices than ever before. But not all PBMs operate on the same model. As a transparent PBM and pass-through PBM, MedOne remains committed to providing transparency in pharmacy benefits, meaningful clinical oversight, personal member support, clear reporting, and the ability to adapt as the market evolves.

If you're looking for a PBM for employers or a PBM for brokers that prioritizes alignment, accountability, and service, we'd welcome the opportunity to show you the MedOne difference.

Future-Proof Your Benefits | MedOne News | MedOne - Pharmacy Benefit Solutions
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Future-Proof Your Benefits

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The Secret to FUNding a Great Employee Benefit

As HR professionals across the country begin to turn their attention to the benefit suite with a communal groan, friendly reminder that it doesn’t have to be the most dreaded talk of the year! 

One of the biggest opportunities organizations overlook is hidden within their pharmacy benefit spend. Here at MedOne we have historically hit a PMPM that is over 40% lower than the industry average. Now that is a meaningful difference. A difference that can unlock real tangible value and benefits for your organization. So, the question is, what would you do with that extra 40% of your pharmacy benefit budget?  

Making the move to MedOne does not just reduce cost for you but also creates increased flexibility and opportunity. It frees up funds that can be strategically reinvested into areas that matter most: Helping you better support your workforce while also strengthening your overall business strategy. Instead of simply managing expenses, you’re able to redirect those dollars into benefits and initiatives that truly make a difference. 

Here are a few ideas (that were really fun to gather) that you might consider offering your employees as part of your benefit suite. Some are derived from conversations with our own clients and colleagues. Others are just plain old fun. Check them out: 

  • Lower Health Premiums: A given. Reinvesting budget surplus directly into healthcare premiums shields your employees from rising costs and increases their take-home pay. 

  • Retirement Fund Matches: Boosting your 401(k) or pension match provides employees with long-term financial security and demonstrates a commitment to their future. 

  • Employee Bonuses: Awarding extra financial bonuses directly rewards hard work, boosts morale, and shows immediate appreciation for your team's dedication. 

  • Childcare Stipends: A hot topic as these costs continue to rise. Providing monthly childcare stipends eases a massive financial burden for working parents and significantly improves workplace retention. 

  • Charitable Donations: Matching employee donations to their favorite charities aligns corporate values with personal passions to build a purpose-driven culture 

  • Office Updates: Now might be the time to take a look at anything that is stained, bent or broken. Refreshing your physical workspace with ergonomic furniture or modern collaborative areas creates a more inviting and productive work environment.  

  • Team Building Outings: Hosting off-site experiences and social events breaks down departmental silos/isolation and builds genuine personal connections among staff. 

  • Enhanced Wellness Programs: Expanding wellness initiatives to include nutrition coaching, sleep apps, and ergonomic assessments addresses employee health more holistically, which could come with additional financial benefits down the line to you, the plan sponsor. 

  • Mental Health Support: Offering dedicated mental health days and/or accessible counseling services combats burnout and prioritizes mental and emotional well-being. 

  • Technology Upgrades: Equipping your team with the latest laptops, software subscriptions, and hardware eliminates daily tech frustrations and accelerates productivity. 

  • Daily Appreciation & Merch: Stocking the office with catered lunches, high-quality company swag, coffee carts, massage therapists, and/or unexpected gifts creates a vibrant, Instagram-worthy workplace culture your team can’t wait to brag about. 

  • Professional Development: Funding industry certifications and leadership conferences helps employees grow their skill sets and advance their careers within your company. 

While there is A LOT that could be done in these areas, the possibilities are truly endless! Every organization can tailor these opportunities to fit their unique culture and goals. 

But at the end of the day, it is not just about cutting costs; it is about building a better business environment that prioritizes and empowers your people to perform their very best. It's about building a benefit strategy that evolves with your workforce and supports what you value the most. 

Making the move to a modern PBM like MedOne could hand you back 40% of your pharmacy benefit budget, giving you the ability to think outside the box and deliver more meaningful benefits. Ultimately, that shift could be exactly what helps future proof your employee benefits strategy and your organization as a whole.  

From Trial to Market: The FDA approval process | MedOne News | MedOne - Pharmacy Benefit Solutions
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From Trial to Market: The FDA approval process

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How New Drugs Come to Market

Every prescription medication that comes to market must go through a long and strict process created by the FDA. Whether it's for a headache or a serious illness, all drugs have gone through this highly regulated journey before it reaches a patient's hands. It is much like how a bill becomes a law; the drug must pass a multitude of “checkpoints” to ensure it is safe, effective, and of the highest quality. 

The U.S. Food and Drug Administration (FDA) is the premier federal consumer protection agency within the Department of Health and Human Services (HHS). The core mission of the FDA is to protect public health by ensuring the safety and security of human and veterinary drugs, the nation's food supply, and other such roles. Their authority dictates that any product manufactured, processed, or distributed in the U.S. (including imports) must meet many rigorous standards to ensure the health and safety of the American population. 

In pharmacy, the FDA protects consumers by ensuring no drug reaches the public without first proving its safety and efficacy. Below outlines the major milestones a prescription medication must reach to unlock FDA approval and enter the market.

Research

First, the process begins in the laboratory. “Drug discovery” is the foundational stage of drug development, where researchers and scientists search for potential compounds to develop new medicines. Scientists then identify a disease or condition they want to treat and then search for a biological target, such as a protein or gene involved in that disease. They choose these targets based on how they can relate to the disease and how well treatments can affect them. After the targets are validated, researchers search for compounds that can interact with them and modify their activity in a desired manner. This stage is known as hit identification. Scientists will screen libraries of compounds or use computational methods to find potential hits, or molecules that work well against the target. Most will fail, but a few promising options will move forward.

Preclinical development is the crucial testing phase before it is moved on to human trials. This includes laboratory and animal studies where research focuses on safety and how the drug behaves in the body (absorption, distribution, metabolism). If the results are promising, the drug sponsor submits an Investigational New Drug (IND) application to the FDA. The IND includes preclinical data, manufacturing information, and plans for human clinical trials. The FDA has 30 days to review the application. If there are no major safety concerns, the drug is cleared to begin clinical trials.

Clinical Trials

Clinical trials are the last step of the testing stage and are split into three phases. Phase One is conducted in controlled settings with a group of 20-100 appropriate, healthy volunteers. The focus of this stage being safety, dosage, and side effects. Researchers determine how the drug behaves in the human body and identify safe dosage levels. This initial step establishes the baseline for a drug's safety. According to the University of Cincinnati College of Medicine, a Phase One trial can take several months to complete and about 70% of experimental drugs pass this initial phase of testing.

Phase Two studies will determine how effective the drug is on a particular disease or condition in approximately 100-300 volunteers. The question that is being asked is, Does Drug X improve Disease Y? This phase could last from several months to two years long. The drug developers are free to ask for help from the FDA at any point in the testing and development process. These questions for help could be about, proposed end date, sufficient planning, data questions, and others.

Phase Three is the last phase of clinical testing and is conducted at multiple centers with several hundred to several thousand patients for whom the drug is intended to help. Phase Three trials are what provide the bulk of information that is needed for the package insert and labeling of a medicine, after it has been approved by the FDA. 

Regulatory Approval

After clinical trials are successfully completed, the drug enters the regulatory review process. This is where the manufacturer submits a New Drug Application (NDA) or a biologics license application (BLA) to the FDA. This application contains all the data from preclinical and clinical testing along with manufacturing details and proposed labeling. The FDA will then assemble a team of experts to evaluate whether the drug is safe, effective, and whether its benefits do in fact outweigh the risks. Also, during this process, the FDA may inspect manufacturing facilities and consult advisory committees for additional input. Once the FDA has approved an NDA/BLA, the drug may enter the US market, but the FDA continues to address and monitor many key areas drug production, distribution, labeling, safety, direct to consumer advertising, use, and risk management. 

Market Access and Pricing

After the drug is approved by the FDA, a pharmaceutical company must establish its Wholesale Acquisition Cost (WAC), then publish it to a drug compendia, a standardized, comprehensive database or reference book that summarizes detailed information about medications, including their approved uses, dosages, side effects, and pricing. Then they must negotiate with Pharmacy Benefit Managers (us!) for formulary placement, coverage, and patient access. 

P&T Evaluation and Formulary Placement 

MedOne’s Pharmacy & Therapeutics (P&T) Committee are integral to the formulary review and placement process. This committee consists of a wide variety of viewpoints, representing the key stakeholders in our field. Members of the committee range from client and community representatives to pharmacists, clinicians, and analysts. The inclusion of internal AND external stakeholders ensure that decisions are evidence-based and not based solely on cost or rebate yield (a common practice is the pharmacy space). 

Quarterly, this committee meets to review the safety, effectiveness, cost, and other factors of any new-to-market medications and determine if and where the drug is placed in our formulary. Together, these members work to balance clinical effectiveness, cost, and patient access when making the formulary decisions. This ensures that MedOne provides safe, effective, and affordable medication options for our clients and members. 

This process of bringing a prescription drug to patients involves several important steps. From initial research and testing to pricing, marketing, and placement, a medication sees a long journey before it makes its way into the pill bottles of patients. 

This multi-faceted framework ensures that all elements of the drug chain work together to ensure patients in the United States receive medications that are safe, effective, and accessible which, hey, that sounds much like our mission.

Biosimilars & Generics: What you need to know | MedOne News | MedOne - Pharmacy Benefit Solutions
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Biosimilars & Generics: What you need to know

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What’s the difference and why does it matter? 

When industry professionals tout “lower-cost alternatives,” generics and biosimilars often get lumped together as they both are indeed often lower-cost alternatives to higher-cost brand and specialty medications. Any pharmacy benefit plan worth its weight should have both featured in the drug mix. However, it’s important to understand the differences and cost implications of adopting both as part of your benefit spend philosophy. 

Both generics and biosimilars are based on FDA-approved medications. Both are intended to be safe, effective options that cost less than brand name medications.  

However, generics and biosimilars are developed differently, approved differently, and managed differently. The key is understanding that distinction matters, especially as specialty medications costs continue to drive pharmacy spend for employers.  

What is a generic medication? 

Generic medications are copies of brand name medications made using the same chemical structure. They contain the same active ingredient, in the same strength and dosage form, and they are expected to work the same way in the body.  

Because medications are well-defined chemical compounds with known active ingredients and structures, they can be reproduced precisely. That’s why generics are typically interchangeable with their brand counterparts at the pharmacy. A status, though, which must be officially granted by the FDA.  

When new generics enter the market, competition quickly follows. Prices drop, access improves, and employers see savings. Generics have been a foundational cost-control tool in pharmacy benefits for decades, and will continue to be a large driver of savings as adoption rates among your member populations rise. 

What is a biosimilar?  

Biosimilars are a type of “biologic” medication, a complex drug manufactured with living components. These living or organic life sources can include microorganisms, bacteria, yeast, or plant or animal cells. Because these components come from living systems, they are far more complex than traditional medications. A biosimilar, therefore, is not an exact copy of its reference product due to it being derived from a living organism. Instead, it is highly similar and produces near identical clinical outcomes and safety concerns as the reference product. Biosimilars, like generics, are medications that have the same safety and effectiveness as medications already licensed in the market. The FDA refers to those original medications as reference products.  

The living nature of biosimilars also makes these drugs more expensive to produce than normal drugs due to development costs and limited competition. This means that all biosimilars that enter the market are in the specialty space.  

Biologics are used for blood and blood product transfusions, stem cell and antibody therapies, and treatment of complex conditions like psoriasis, autoimmune and inflammatory bowel diseases, rheumatoid arthritis, diabetes, and cancer.  

Market Approval for Biosimilars 

To achieve FDA approval, the main active ingredient structure must match the reference product; inactive ingredients, called excipients, may differ. Before approval, the FDA requires extensive data to confirm there is no meaningful clinical difference between the biosimilar and the reference product.  

That review includes detailed analysis of the medications structure, how it behaves in the body, how it is manufactured, and how it performs in clinical studies.  

To receive FDA approval, a biosimilar must:  

  • Be administered in the same way 

  • Have the same strength and dosage form 

  • Carry the same potential side effects  

These strict standards ensure biosimilars deliver the same safety and effectiveness patients expect from the reference biologic. 

Biosimilars vs generics at a glance  

Why does this matter for employers? 

Specialty medications represent a growing share of pharmacy spend, even though they are used by a smaller percentage of the member population. Using biosimilars of widely utilized specialty medications creates an opportunity to manage that spend more effectively. 

Savings may not appear overnight, but when adoption is intentional, biosimilars can reduce costs while keeping care clinically appropriate and consistent for members. 

Biosimilars: An RxAlly Strategy 

Here at MedOne, biosimilars are approached with purpose. Within RxAlly, our suite of specialty cost containment solutions are evaluated carefully and positioned where they make sense clinically and financially for our members.  

Here are only a couple of examples of how this plays out for our members.  

Humira® to Yusimry® 

Humira has been one of the most expensive medications to cover on a pharmacy benefit for years. Up until 2021, it was the number one medication in world-wide sales for almost 10 years.  

Through a direct buy agreement with Mark Cuban Cost Plus Drug Company, MedOne members can access Humira biosimilars at deeply discounted prices, delivering savings of up to 93.5% compared to Humira. Because of this pricing, Yusimry is the preferred Humira biosimilar as it offers the lowest net cost. RxAlly Patient Care Coordinators (PCCs) help members transition from the brand name to the biosimilar as part of the RxAlly program enrollment process. Two 40mg pens of Humira can cost $2,000+, but when switching to Yusimry, that costs comes down to just over $600 for the same dosage and number of pens. The switch is required to ensure consistent savings for both members and their plan sponsors, with exceptions made when clinically necessary.  

Stelara® to Starjemza™ 

Similar to the previous example, Stelara biosimilars opened new savings opportunities in regard to the treatment of inflammatory conditions. One 90mg dose of Stelara can cost upwards of $7,500 but when switching to Starjemza the member was able to pay less than $500 for the same dosage. When appropriate, shifting utilization to options like Starjemza helps employers reduce specialty spending while keeping care consistent for members.  

Clear formulary decisions, clinical oversight, and communication are what drive results at MedOne to deliver these results. When those pieces are in place, biosimilars become a reliable part of managing specialty medication costs.

Why It Matters  

The use of generic and biosimilar medications are tools in which plan sponsors can better control their pharmacy spend.  

Generics provide predictable savings for traditional medications, while biosimilars offer growing opportunities to manage specialty drug spend when they are adopted thoughtfully. When members are guided to the lowest net cost option for their medication treatment without compromising care, that’s a win-win for them and their plan sponsors.  

At MedOne, we view biosimilars as a practical way to improve affordability and access while keeping clinical outcomes front and center, aligning with our mission to help people access the right medication at the best price. 

Foundayo: An easier pill to swallow? | MedOne News | MedOne - Pharmacy Benefit Solutions
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Foundayo: An easier pill to swallow?

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Oral GLP‑1s Enter the Market

Earlier this spring, Eli Lilly received FDA approval for FoundayoTM (orforglipron), the first GLP‑1 pill that can be taken any time of day without food or water restrictions. For patients who have struggled with the rigid dosing rules tied to oral Wegovy®, this is a game-changing shift.

The only other oral option available requires that it be taken on an empty stomach with no more than four ounces of water. Given these restrictions, there is also a required waiting period before the patient is able to eat. These barriers are not applicable with Foundayo. From a convenience standpoint, this is huge. It allows patients to worry less about their prescription medication regimen and more about living their lives. Fewer rules and restrictions, too, can translate to better adherence and health outcomes.

However, administration and adherence is only one piece of the puzzle. 

What the Clinical Data Shows

Foundayo was approved through the Commissioner’s National Priority Voucher (CNPV) program based on results from its Phase 3 trial. In the ATTAIN‑1 trial, patients without diabetes taking the highest dose of Foundayo lost an average of 11-12% of their body weight over 72 weeks. Lower doses produced less weight loss. In ATTAIN‑2, which included patients with type 2 diabetes, average weight loss ranged from about 5-10%, depending on dose. 

Injectable agents such as semaglutide and tirzepatide continue to show greater average weight loss in head‑to‑head comparisons across the broader GLP‑1 category, but no head-to-head clinical trials comparing the Wegovy tablet and the Foundayo tablet have been conducted. 

Side effects were also consistent with what we see across GLP‑1 therapies. Gastrointestinal issues, including nausea, vomiting, diarrhea, and constipation, were common. Discontinuation rates were higher with Foundayo than placebo, particularly at higher doses. In other words, the trial results do not suggest that removing injections would remove tolerability concerns.

Formulary Review and Placement at MedOne

As with all new‑to‑market medications, Foundayo was reviewed by the MedOne Pharmacy & Therapeutics (P&T) Committee.

Based on the available clinical data, cost considerations, and comparative effectiveness, the committee determined the following:

  • Non‑formulary on the Performance Formulary
  • Non‑preferred on the Access Formulary

This decision reflects what the data shows today. While Foundayo offers dosing flexibility, it does not demonstrate improved outcomes over existing GLP‑1 options, and side effects remain prevalent. From a plan sponsor perspective, broader access would likely increase spend without a clear clinical upside.

What This Means for Employers and Members

GLP‑1s continue to be a large driver of plan spend. New formulations, generics, and alternatives will continue to enter the market, each one will come with its own balance of convenience, effectiveness, and cost.

Foundayo may appeal to patients who strongly prefer an oral option and are willing to accept more modest results. For employers and plans, however, the focus remains the same: aligning coverage decisions with therapies that deliver meaningful outcomes relative to their cost.

At MedOne, we will continue to monitor utilization across our book of business. If that picture changes, formulary placement can change with it. Until then, our approach stays grounded in evidence, transparency, and helping clients make informed decisions in a crowded and fast‑moving GLP‑1 landscape.

The Anatomy of a Proposal | MedOne News | MedOne - Pharmacy Benefit Solutions
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The Anatomy of a Proposal

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When reviewing a PBM proposal, it’s not all about the bottom line. While it’s certainly important, it’s equally as important for self-funded employers and their broker partners to understand how that number was built, what is guaranteed, and what the experience will look like for their members.

A proposal from MedOne Pharmacy Benefit Solutions is structured to answer those questions in a clear and logical way. Each section is designed to show how savings opportunities are created, how pricing works, and how decisions are made before anything is finalized.

1. MedOne’s Savings Waterfall

Every MedOne proposal starts with the Savings Waterfall, as it shows how savings are created step by step when our strategies are implemented. We begin with gross spend and then walk through each strategy that reduces cost before rebates are applied. That includes biosimilar adoption, low value drug exclusions, patient and copay assistance programs, and active management of high-cost categories like GLP‑1s. Each lever is given its own line so brokers and prospective clients can see what is driving change and what assumptions sit behind the numbers. From there, rebates are passed through in full, administrative fees are clearly listed, and member cost share is accounted for, landing on a true net spend. You should be able to follow the math, explain it to a client, and trust that the savings shown reflect how the plan will actually be managed.

2. Financial Terms

Once the savings are clearly laid out, the proposal moves into financial terms. This section is about setting expectations and removing uncertainty. MedOne pricing is built around minimum guarantees, not optimistic projections. Discount guarantees are shown by channel and drug type, with dispensing fees listed clearly. Rebate guarantees are separated by formulary types so brokers and prospective clients can see how those decisions impact results. 

Administrative fees are handled the same way. Instead of tying revenue to drug spend, MedOne uses a transparent per member per month (PMPM) fee. Core services like implementation, claims processing, account management, pharmacist access, reporting, and standard clinical programs are included, not added later as line items. Optional programs are clearly identified with straightforward pricing, whether that is a per review fee or shared savings. The result is a proposal where you know what you are paying for, what is included, and how MedOne gets paid. Financial terms that are easy to explain and easier to trust.

3. Network Disruption Analysis

The final section of the proposal looks at network disruption because pricing only works if members can still fill their prescriptions without friction. MedOne owns and manages our own pharmacy network, which gives us more options and greater control when evaluating network design. In the proposal, we show exactly how many pharmacies and claims are in network today, what percentage fall outside the network, and which locations (and members!) may be impacted. That analysis helps brokers and prospective clients understand the real tradeoffs before any changes are made.

In cases where disruption is minimal, MedOne can pursue deeper discounts or tighter network strategies with confidence. When disruption is higher, we walk through alternatives and talk through the impact by employer group. The goal is to balance access, member experience, and cost in a way that fits the plan, not force a network decision that looks good on paper but creates issues for members.

Together, MedOne proposals give brokers and prospective clients a full view of how MedOne approaches pharmacy benefit management. The savings are clearly built, the financial terms are easy to follow, and network decisions are evaluated with member impact in mind. The goal is simple: Make it easier to understand the plan, easier to explain the plan, and easier to trust the results once the plan is live.

MedOne and Nanodropper Announce Early Success of MediSplit Program | MedOne News | MedOne - Pharmacy Benefit Solutions
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MedOne and Nanodropper Announce Early Success of MediSplit Program

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Rochester, March 26, 2026 — MedOne Pharmacy Benefit Solutions, an innovative pharmacy benefit manager (PBM) focused on outcomes-driven care, and Nanodropper, a leader in precision medication delivery solutions, today announced early results from the MediSplit program, a value-based clinical care path designed to improve medication adherence and reduce side effects for patients using prescription eye drops.

The MediSplit program provides eligible MedOne members with complimentary Nanodroppers when filling select ophthalmic prescriptions. The initiative aims to address common challenges associated with eye drop medications, including waste, inconsistent dosing, and treatment-related side effects.

Nanodropper’s device reduces the volume of each eye drop, helping patients extend the life of their medication while minimizing systemic exposure that can contribute to side effects. When deployed at scale through MedOne’s pharmacy network, the solution offers a promising pathway for improved outcomes and cost efficiencies.

Early outcomes from the program demonstrate significant improvements in both adherence and patient experience:

  • 100% of participants reported never missing a dose due to running out of medication, compared to 40% prior to using Nanodropper
  • 100% reported never missing a dose due to unwanted side effects, down from 20%
  • 100% of participants indicated they would like to continue receiving Nanodroppers
  • 36% reported a reduction in side effect prevalence, while 53% reported a reduction in side effect severity

These results highlight the potential of pairing innovative medical devices with pharmacy benefits to drive meaningful clinical and behavioral outcomes.

“The partnership with Nanodropper adds an innovative enhancement to this clinical program focusing on limiting waste and delivering savings to clients and patients,” said Dr. Nathan Harold, Chief Pharmacy Officer at MedOne. “Our clients trust us to be responsible stewards of their resources, and the MediSplit program is one of our many strategies that keep their best interests in mind.”

The MediSplit program represents a new model for pharmacy benefit design: integrating medical devices as value-based services. By aligning incentives around outcomes rather than utilization, the program demonstrates how simple, low-cost interventions can significantly enhance both patient adherence and overall treatment experience.

Demonstrated Cost Savings and ROI

Patients enrolled in the MediSplit program were using eye drop medications costing health plans as much as $412 per month. By utilizing Nanodropper, MedOne achieved:

  • 36% reduction in prescription drug costs for enrolled patients
  • Average savings of $109 per claim
  • Up to $160 PMPM savings per medication

These early financial outcomes reinforce the value-based structure of the MediSplit program, demonstrating that improved clinical outcomes can be achieved alongside meaningful cost reductions for payers and employers.

“MedOne’s leadership in launching MediSplit reflects a broader shift toward outcomes-driven pharmacy care,” said Dr. Alissa Song, CEO and Founder of Nanodropper. “These early results validate the role that precision delivery tools can play in improving adherence, reducing side effects, and supporting value-based care models for payers and employers.”

As healthcare stakeholders continue to seek innovative solutions that balance cost and quality, the MediSplit program serves as a proof point for the integration of medical devices into value-based pharmacy strategies.

 

About MedOne

MedOne is a transparent pharmacy benefit manager (PBM) dedicated to unlocking the right prescription medications at the best prices for self-funded employers and their members. By aligning financial incentives and leveraging innovative clinical programs, MedOne focuses on enhancing the members’ pharmacy benefit experience, improving clinical outcomes, and reducing overall net cost.

About Nanodropper

Nanodropper is a healthcare technology company focused on improving medication delivery through precision dosing solutions. Its flagship device is designed to optimize eye drop administration, helping patients reduce waste, improve adherence, and minimize side effects.

Start Your Smoke-Free Future | MedOne News | MedOne - Pharmacy Benefit Solutions
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Start Your Smoke-Free Future

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Start Your Smoke-Free Future

Quitting tobacco can be challenging, especially when trying to do it alone. MedOne, in partnership with our clients, can help support members on their journey to becoming smoke-free. With the right tools and guidance, quitting is possible. The CDC states that nearly 70% of adults who smoke say they want to quit, yet fewer than 1 in 10 are able to quit successfully each year.

MedOne offers support in a variety of ways. Many former smokers have found that adding medication treatments to their quit plan can make a real difference. The member’s provider can help determine the best approach for their individual needs. While these treatments can be effective, they are not a “cure” on their own. However, the therapies included below can be the path toward a smoke-free future. 

Nicotine Replacement Therapy

Nicotine Replacement Therapy, also known as NRT, works by delivering a small, controlled amount of nicotine to help curb cravings and reduce the urge to smoke. Studies show these products are safe for most individuals and are available over the counter or by prescription. Common NRT options include:

  • Nicotine patch
  • Nicotine gum
  • Nicotine lozenge
  • Nicotine nasal spray
  • Nicotine inhaler

Non-Nicotine Prescription Medications

Some medications do not contain nicotine but can still help reduce cravings and withdrawal symptoms. A prescriber may recommend one of the following prescription options:

  • Bupropion SR
  • Varenicline

These medications require a prescription and should be used under the guidance of a healthcare provider.

Combination Therapy

Some individuals may benefit from combination therapy, which involves using more than one quitting aid at the same time. This may include using two forms of Nicotine Replacement Therapy or combining an NRT product with a prescription medication. 

Quitting Is Easier with Support

Smokers are one and a half times more likely to successfully quit smoking when prescription medication is paired with the right kind of support. This can include coaching, counseling, or even check‑ins and encouragement from loved ones or peers throughout the quit journey. Having a mix of guidance and accountability makes the process easier and more effective.

There is more than one path to becoming smoke-free, and the best plan is the one that works best for the member. Support plays a huge role in making that plan stick, whether it comes from coaching, counseling, or regular check-ins. Quitting can lower the risk of serious health problems and is one of the strongest steps members can take to prioritize long-term health goals. MedOne is here to help find the approach that fits the needs of members, supporting them along the way.

MedOne Announces 2026 Promotions | MedOne News | MedOne - Pharmacy Benefit Solutions
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MedOne Announces 2026 Promotions

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DUBUQUE, Iowa, March 5, 2026 – MedOne Pharmacy Benefit Solutions is pleased to announce the latest round of employee promotions. These promotions highlight the leaders, contributors, and technical experts whose work strengthens MedOne’s ability to deliver industry-leading service to members, clients, and partners. This announcement reflects MedOne’s ongoing commitment to innovation, operational excellence, and sustained growth across all business units. 


“These individuals continue to demonstrate exceptional leadership, passion, and commitment to excellence. Please join me in celebrating their achievements and the positive impact they bring to our teams every day,” said Senior Human Resources Manager Jolene Kohlenberg, SHRM-CP.
Join us in congratulating each of these individuals on their well-deserved promotions:


Business Architecture

With eight years of service to MedOne and extensive expertise building and testing plan designs within our claims adjudication system Jenny Nelson, CPhT, was promoted to Plan Administration Supervisor. Her work ensures clients’ benefit plans are built accurately, a vital piece of pharmacy benefit management. We look forward to her leading, mentoring, and overseeing our other members of the Plan Administration staff
 

People, Accounting, & Legal

Molly Ties, former Controller, was promoted to Vice President of Finance. This advancement reflects her leadership, strategic thinking, and the financial stewardship she has brought to MedOne’s expanding operations.
 

Pharmacy Services

Dr. Michelle Lange, RPh, PharmD. was promoted to Mail Order Pharmacist II. A steady presence within MedOne Pharmacy Services since 2021, she plays a critical role in the daily operations of the pharmacy and training of new team members.


Information Technology

Nathan Luebbert was named Lead Solutions Developer. A longtime member of the Development Team, Nathan will continue to. design, develop, and maintain software solutions, advancing and supporting our behind-the-scenes business operations
Elizabeth Mortonson, MS, LAT, ATC, and Hannah Foster have been promoted to Data Analyst II and Data Analyst I, respectively. Both bring strong technical expertise and have played meaningful roles in expanding MedOne’s data capabilities, key pieces of our day-to-day operations. We look forward to their continued growth and achievements in our Data Services department. 


Clinical Services

Shelby Jones, MHA, CPhT, was appointed Director of Clinical Operations. A key asset to the Clinical team, she will continue to lead MedOne’s clinical programs, operations, and reporting capabilities.
Dr. Norman Westervelt, RPh, Pharm.D. was promoted to Director of Clinical Account Management. Dr. Norman’s partnership approach and steady focus on service continue to elevate the Clinical Account Management Team’s quality of service.
Tieara Richardson was promoted to Data Entry Specialist II. Her consistency and efficiency have strengthened the Clinical Team’s workflows.


Client Services

Rounding it out is a group of Strategic Account Executives who stepped into new roles. Lisa Davis, Baylie Heppner, Kirsten DeSanto, and Alicia Miller were promoted to Manager, Client Strategy. Known for fostering strong client relationships and delivering outstanding service, this group’s expanded leadership will continue strengthening MedOne’s client experience and strategic account support.


These promotions reflect MedOne’s continued investment in people, technology, and service infrastructure as we continue to scale our capabilities in an ever-evolving pharmacy benefits landscape. 
 

For more information about MedOne Pharmacy Benefit Solutions, our team, or our open positions, visit medone rx.com.
 

Gateway Business Health Coalition & MedOne Pharmacy Benefit Solutions Partner to Bring Transparent PBM Services | MedOne News | MedOne - Pharmacy Benefit Solutions
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Gateway Business Health Coalition & MedOne Pharmacy Benefit Solutions Partner to Bring Transparent PBM Services

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DUBUQUE, February 26, 2026 — The Gateway Business Health Coalition (Gateway BHC) announced it has selected MedOne Pharmacy Benefit as one of its preferred pharmacy benefit management (PBM) partners.  

The partnership aligns MedOne’s transparent, service-driven PBM model with Gateway BHC’s mission to support employer efforts to improve employee wellbeing and strengthen the value of their health benefit investments.  

“We are excited to welcome MedOne as a vendor partner in Gateway BHC’s Pharmacy Management Initiative,” said Laurel Pickering, President and CEO of Gateway Business Health Coalition. “As employers navigate unprecedented pressure to control pharmacy costs, meet new fiduciary obligations, and support their workforce, adding MedOne strengthens our commitment to transparency, disciplined cost management, and solutions that advance both financial sustainability and member experience.”  

Since 1982, the Gateway Business Health Coalition has represented leading employers nationwide, working to ensure organizations have the tools, insights, and collective voice needed to advance high-quality, value-driven health care. The coalition focuses on helping employers enhance the well-being of their workforce while improving the overall effectiveness of their health benefits. 

“MedOne is honored to be selected as a preferred PBM partner by the Gateway Business Health Coalition,” said Matthew Lee, VP of Sales & Marketing. “Our organizations share a common commitment: delivering clarity, value, and improved outcomes for employers and employees alike.” 

Family-founded and owned since 1999, MedOne brings full ownership of all core PBM capabilities, including comprehensive specialty cost containment solutions and a nationwide pharmacy network. Operating under a 100% passthrough, fully transparent model, MedOne guarantees savings and pairs proven financial results with exceptional member service. 

MedOne’s integrated model features an in-house cost-plus specialty and mail-order pharmacy, supported by a team of certified pharmacy technicians who respond directly to member, pharmacy, and prescriber needs. This complete control of operations allows MedOne to be nimble, quickly respond to industry changes, and deliver a PBM experience that consistently saves, outperforms, delivers, and wows. 

MedOne was chosen by the Gateway BHC through a process led by Foundational Pharmacy Strategies, acquired by MacroHealth in June of 2025,  which culminated in a PBM Innovation Forum hosted by Gateway BHC. MedOne’s partnership with the Gateway Business Health Coalition reflects both organizations’ shared dedication to transparency, innovation, and employer-driven health care solutions.   

For more on the Gateway Business Health Coalition, visit gatewaybhc.org. For more information about MedOne Pharmacy Benefit Solutions, visit medone-rx.com. 

About Gateway Business Health Coalition 

Since 1982, the Gateway Business Health Coalition has supported employer efforts to improve the well-being of their enrollees and enhance the quality and overall value of their investments in health benefits. A non-profit organization based out of St. Louis, Missouri, and serving members across the US, the Gateway BHC strives to make health care work better for businesses, their employees, and the communities they call home. 

About MedOne Pharmacy Benefit Solutions 

MedOne helps organizations and their health plan members conveniently access the most appropriate prescription at the most affordable price through its aligned and performance-based pharmacy benefit solution. MedOne’s offering focuses on enhancing the member’s pharmacy benefit experience, improving clinical outcomes, and reducing net cost for plan sponsors and their members. MedOne operates in all 50 states, and its customer base includes organizations of all sizes and across a variety of industries. MedOne is honored to be included in the 2024 Inc. Magazine’s 5000 fastest-growing private companies in America and one of Iowa's Top Workplaces in 2025. For more information, visit www.medone-rx.com. 

About MacroHealth and Foundational Pharmacy Strategies 
Trusted by leading healthcare Payers and enterprises, MacroHealth is modernizing the healthcare marketplace to measurably improve access, cost, and quality. MacroHealth’s Intelligent Health Market-as-a-Service (IHMaaS) platform leverages data science and industry-standard interoperability to enable Payers and Health Market Partners to optimize and connect their unique healthcare ecosystems. In 2025, MacroHealth purchased Foundational Pharmacy Strategies to bolster its IHMaaS, expand its offerings into the pharmaceutical space, and reduce prescription costs.  To learn more, visit: www.macrohealth.com 
 
Contacts 
For questions and media inquiries, contact Karen Poston, Gateway Business Health Coalition, (314)-721-7800 ext. 105 or kposton@gatewaybhc.org

Five Key PBM Trends to Watch in 2026 | MedOne News | MedOne - Pharmacy Benefit Solutions
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Five Key PBM Trends to Watch in 2026

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As we dive headfirst into the 2026 fiscal year, one thing is certain: the pharmacy benefit management (PBM) landscape shows no signs of slowing down. Market forces, regulatory pressure, new-to-market medications, and shifting patient and payor expectations continue to reshape how employers, consultants, and PBMs work together to manage prescription benefits.

At MedOne, we closely monitor these dynamics to help our clients stay ahead of what’s coming, not just react to it. Here are the five key PBM trends we believe will define 2026 and beyond.

1. There is No “Silver Bullet” Solution

If 2025 taught us anything, it’s that there is no universal PBM strategy that works for every employer. Every population, every plan design, and every budget requires a tailored approach. Groups taking the time to understand their unique drivers of spend (typically specialty utilization, chronic conditions, etc.. more on that in a different article!) saw the strongest results. One-size-fits-all strategies simply don’t hold up in today’s environment.

In 2026, we expect to see even more organizations shifting toward custom-built plan designs designed around their specific benefit strategies. These include the specific health outcomes desired for members, risk tolerance, and cost‑containment goals. Flexibility and alignment will continue to matter more than cookie-cutter PBM models.

2. GLP 1s Are Here to Stay

GLP‑1 medications for weight‑loss and diabetes management continue to dominate the conversation, and the trend isn’t slowing. Employers who straddled the fence last year often saw more volatility than those who committed to a strategy and stayed the course. Whether your organization opts for full coverage, limited coverage, outcomes‑based criteria, or straight-up exclusion, the key for 2026 is consistency. Members need to know what to expect about coverage of GLP-1s. 

With new GLP-1 formulations and expanded indications (#IndicationNation?) coming, a thoughtful long‑term approach is essential.

3. Biosimilars Continue Their Momentum

The biosimilar market grew substantially in 2025, and one of the biggest success stories was the introduction of Stelara biosimilars. These alternatives demonstrated real opportunities to reduce specialty spend without compromising clinical outcomes. As additional biosimilars enter the market in 2026, from inflammatory conditions to oncology and beyond, we anticipate even more savings opportunities for employers who are ready to adopt them.

The key will be balancing swift action with sound clinical oversight. Biosimilars work best when they are proactively integrated into formulary strategy, prescriber education, and member communication.

4. Direct to Consumer Models Are Expanding

Direct‑to‑consumer (DTC) pharmacy models and cash‑pay initiatives continued to pop up in 2025, and into the new year with the launch of TrumpRx, for example. These options advertise offering prices lower than what a member would pay through their benefit card. That trend will only continue accelerate in 2026.

While these programs can bring real savings to members, they also create challenges for plan sponsors trying to track utilization, coordinate clinical interventions, or maintain accurate reporting. The future isn’t about competing with these programs but integrating them. We believe that wherever it comes from, may the best price win! It just comes down to working collaboratively with the DTC options to ensure members access the best price and that the plan has visibility into the total cost of care.

5. Flexibility Is the Name of the Game

If there’s a single theme that ties everything together this year, it’s flexibility. The PBM industry is evolving faster than ever. Organizations that thrive in this environment are the ones that can pivot quickly. That means the ability to be nimble when designing the benefit, transparent communication channels, and the right partner built on the right model with the right alignment is the key to success.

At MedOne, flexibility is the backbone of how we operate. Our fully transparent, pass-through model and in-house capabilities allow us to respond quickly as market conditions shift, helping our clients stay proactive rather than reactive.

The PBM landscape will continue to challenge, change, and surprise throughout 2026 and beyond. But with a clear strategy, the right partners (hi there!), and a willingness to adapt, employers can navigate these twists and turns with confidence.

At MedOne, we’ll keep monitoring the data, listening to our clients, and innovating on their behalf because our goal remains the same: deliver a PBM experience that saves, outperforms, delivers, and truly wows. 

The Two Types of PBMs: Transparent vs Traditional | MedOne News | MedOne - Pharmacy Benefit Solutions
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The Two Types of PBMs: Transparent vs Traditional

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The model on which your PBM operates doesn’t just affect your bottom line; it shapes how your plan is managed, how your members experience care, and your ability to control pharmacy spend. Familiarizing yourself with these models and identifying a partner that best aligns with your overall benefit strategy will help plan sponsors make smarter, sustainable, and better-informed decisions for their organizations. 

When researching pharmacy benefit managers (PBMs), self-funded employers and plan sponsors often come across terms like “pass-through,” “transparent pricing,” “spread pricing,” “rebate retention,” and “administrative fees,” which can become overwhelming very quickly. 

Diving into these terms and wading into the world of PBM, you’ll find that at its core, there are primarily two models on which PBMs will operate: the traditional model on which the legacy or “Big 3” PBMs operate and the pass-through, transparent model of the modern or new-age PBMs.

Traditional PBM Model 

Historically, most of the pharmacy benefit marketplace operates on the traditional PBM model. Those that operate this way generate their revenue by building a “spread” into their pricing, earning revenue on each processed claim. 

For instance, let’s say that a drug costs $100, fairly simple. As expected, the PBM invoices the plan for that $100 cost. However, when the PBM goes to reimburse the pharmacy, they might only reimburse the pharmacy $80 for that claim. That extra $20 is the “spread,” otherwise known as revenue in this model. 

This inherently incentivizes an increased quantity of claims. In addition to this spread-pricing practice, manufacturer rebates are typically captured and held by the PBM. Rebates (among others) are a tool drug manufacturers use when pushing their products to market. Traditional PBMs may keep a large portion of the rebates as a sort of “fee” for their service, which makes the true net cost of a drug hard to pin down. 

When plan sponsors look at a traditional PBM, they might see large market share, deep discounts, and big rebate checks as an upside, something that’s fairly straightforward. However, it is difficult to know the true net cost of the medications plan sponsors are paying for and how much the PBM is making on the backend with this model. Many traditional PBMs are built on a moving-target pricing model that make it difficult for employers to understand true costs of the medications that are covered on their plan. Add in rebate retention? It’s game over. 

This traditional model is what prompted MedOne’s founder Dr. Richard Hartig to build a better path forward, creating MedOne Pharmacy Benefit Solutions in 1999 on the basis of transparency.  

Pass-Through or Transparent Model

In the transparent model, PBMs pass the cost of the prescription drug directly to the plan with no markup or spread; plans pay exactly what the PBM pays the pharmacy. In our example from earlier, when the plan kicks in that $100 reimbursement, the pharmacy receives that same $100 and is made whole; there are no hidden markups or added costs. Couple that with any applicable rebates that come through, and your benefit budget turns green before your eyes. 

How does this model generate revenue? Transparent PBMs like MedOne will charge a flat administrative fee, typically charged on a per-member-per-month basis, for their services as outlined in the agreement. Charging this fee based on covered lives shifts the source of revenue from the quantity of claims to the quality of service. 

The pass-through or “transparent” model is a more straightforward model that puts the plan sponsor in the driver’s seat. Oftentimes, the difference between traditional and pass-through PBMs is said to be rebates. Traditional PBMs retain rebates while pass-through models, well, pass those rebates through to their clients. While this is true (and can have a large impact on your bottom line!), transparency goes beyond rebates. 

The other key piece of the transparent model is access. Access to your own claims. Access to invoices and receipts. Access to 1) what the plan is paying and 2) to whom. These components are not always part of the conversation surrounding PBM models, but they rank right up there with pricing, fees, and rebate retention. Transparency is a far-reaching concept that is at the core of what we do here at MedOne. (We even hosted an event fully centered on it!) 

All in all, the difference between a transparent PBM and a traditional one comes down to trust and clarity. Traditional models often leave employers in the dark, unsure of where their money is going or how much their PBM is really making off their account. A transparent model like MedOne brings everything into the light, letting you see exactly what you’re paying for, where the savings go, and how your plan is being managed.

Your 2026 New-Age PBM Checklist | MedOne News | MedOne - Pharmacy Benefit Solutions
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Your 2026 New-Age PBM Checklist

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Pharmacy benefit management plays a critical role in controlling health insurance costs and improving member health outcomes. But not all PBMs are created equal. The right PBM won’t be just another vendor in your benefit suite but a true partner that has your best interests in mind.  

Pharmacy benefit management is evolving, and so are the expectations of employees and plan sponsors. Rising drug costs, complex rebate structures, and member experience challenges make choosing the right PBM partner more critical than ever. But what does the modern, new-age PBM look like? Here's your checklist for success. 

1. Transparent Pricing & A Modern PBM Model 

PBM models have been under the microscope for some time now. The larger, legacy PBMs that operate on a traditional, spread-based model are no longer the primary option. Instead, modern, alternative PBMs offer a transparent, pass-through model that prioritizes upfront pricing and fee structures.  

Look for a modern PBM that offers clear, auditable contracts and pass-through pricing that puts the plan sponsor in the driver’s seat. You might also consider the age of the PBM; buy-outs, mergers, and acquisitions are common in the PBM market, so it’s best to ensure your prospective PBM has deep-seated roots in the pharmacy space and has no plans to sell.  

2. Data That Delivers 

Data drives decisions and empowers decision-makers like you. Your PBM’s transparency should encompass claims data and performance. As the plan’s sponsor, look for real-time access, actionable reporting, and data dashboards that you can customize to display the metrics most important to you and your team.  

At MedOne, we believe in “your data, your way.” Employers and plan sponsors need real-time insights to make informed decisions. Our technology platforms give you the visibility into the utilization, cost trends, and member engagement you need to take control of your pharmacy spend. But we don't stop at dashboards; our team walks you through the data so you can act with confidence, leveraging all the levers available to you, which brings us to… 

3. Service That Stands Out 

With so many moving parts, your PBM should be accessible to both you and your members. For your member population, Look for a knowledgeable, professional, and accessible customer service center, staffed with industry experts who are equipped to answer any questions your membership may have about their pharmacy benefit. Flexible hours, translation services, chat features are all additional features members appreciate.  

On the HR side of things, the “set it and forget it” mindset doesn’t fit the bill anymore. Your PBM should proactively provide you with insights into your pharmacy spend as well as actionable recommendations for how you can achieve the goals of your benefit philosophy. This can only be achieved with a standard of service that really stands out. Your PBM should be responsive to questions and quick to resolve issues, even outside of regularly scheduled meetings. High-quality service is the new standard.    

4. A Member-First Mentality 

Cost savings matter, but not at the expense of member health. Look for a PBM that prioritizes evidence-based decisions and offers programs to improve adherence and drive positive clinical outcomes. Managing a formulary isn't just about cost; it's about ensuring members have access to 1) safe, effective, and appropriate medications 2) at the best price.  

It's easy to lose sight of the big picture when vetting out vendors, but don’t lose track of your members and the experience they can expect with this PBM; they’re the reason you offer the benefit in the first place! Look for a member-centric and experience-oriented PBM that will deliver satisfaction over frustration. Throughout the entire interaction. 

5. A Culture You Can Trust 

Ready for one of the best tricks of the trade when evaluating your PBM? The measuring stick you can use? Look at the employees who work for this PBM. Are they happy? Do they look forward to coming to work? Are they in it for the right reasons? It might seem unconventional to look into a vendor’s company culture, but it feeds the cycle. If those employees love what they do, they’ll bring that same level of respect and commitment to serving you, their clients.  

A PBM's company culture matters. Choose a PBM whose culture mirrors your own. This makes for an aligned business relationship upon which collaboration, innovation, and partnership can thrive. 

Choosing a PBM partner is one of the most important decisions you'll make for your health plan. Setting the checklists and the pros and cons aside, at the end of the day, your decision should come down to this one thing: Do you trust this PBM partner? Do they do things the right way? Do they keep their word? Would you look forward to working with this PBM day in and day out? Based on how often we’re in touch with our clients, we sure hope so! Answering this one question might just whittle down your prospect list. Once you have this answer, you can then go down your checklist.  

Ready to start checking the boxes?  

Chat with our Sales team to get a feel for what it’s like working with MedOne: sales@medone-rx.com. 

A Better Way to Manage Your DMRs with myMedOne | MedOne News | MedOne - Pharmacy Benefit Solutions
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A Better Way to Manage Your DMRs with myMedOne

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The newest feature of myMedOne is here! The Direct Member Reimbursement (DMR) features are designed to make the reimbursement experience easier, more transparent, and stress-free. Though not the most common, there is sometimes a need to process DMRs. These reimbursements cover situations like when members: 

  • Fill at an out-of-network pharmacy.
  • Have outdated insurance on file at a pharmacy forget to present their ID card. 
  • Choose to pay out-of-pocket for their medication for an early or vacation refill. 
  • Fill a compounded medication. 

If, for whatever reason, a member may pay out of pocket for a prescription that should have been covered on the member’s pharmacy benefit, this new process allows for direct reimbursement for that claim. This ensures the member can access the correct pricing under their plan, keeps everything compliant and accurate for reporting, and helps maintain the trust of the member and their pharmacy benefit.  

Effective January 1, 2026, DMR submission is through the online form available to all members. When a member submits a request using this form, it is automatically added to our DMR tracking system, eliminating the need for MedOne employees to manually input and process the request. Members access the online reimbursement option through their myMedOne portal under the CLAIMS sub menu, labeled REIMBURSEMENT. Compound medication requests no longer require a paper form and can now be submitted directly through myMedOne. 

Additionally, members can now add multiple claims within a single DMR form, saving time by avoiding the need to submit a separate form for each medication. After the member enters the details for each claim and clicks ADD, the claim information will appear, and an additional + ADD CLAIM button will be available to include more claims. 

For every request submitted, the member is instructed to attach a copy of the pharmacy receipt and the cash register receipt. After uploading the required documents and agreeing to all the terms, the form will be submitted and is immediately accessible to our team. Upon submission, the member will receive an ACCEPTED text or email if they opted in for notifications and will have the option to edit their notification preferences or return to the Reimbursement Center page. During the submission, members must provide a valid contact phone number and email address so MedOne employees can reach out for any additional information that is needed. 

Once requests are submitted, members can access the DMR Status Page in myMedOne. This provides complete visibility into their past and pending requests, allowing members to see the status of their claims in real time, view detailed notes, and see a full list of all submitted claims, all in one place. Plus, members will receive notifications as their claim status changes, so members are always informed without having to repeatedly log in.

These enhancements are designed to make the reimbursement experience easier, more transparent, and stress-free.

MedOne Earns Top Titles at Des Moines Register Top Workplaces Event | MedOne News | MedOne - Pharmacy Benefit Solutions
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MedOne Earns Top Titles at Des Moines Register Top Workplaces Event

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After earning the title of "Best Places to Work in Dubuque" in 2023 and 2024, MedOne Pharmacy Solutions looked beyond the shores of the "Mighty Mississippi" in 2025. 

MedOne was recognized by Iowa Top Workplaces & the Des Moines Register. The announcement event was held at Prairie Meadows Casino in Altoona, IA, on Wednesday, September 24 and welcomed guests from across the state. In attendance were top-performing organizations representing industries from banking and manufacturing to healthcare and PBM, like MedOne. Invitees to the event included other organizations in the top 10% of the over 4,000 participating entities.

The ranked awards for overall top workplaces in the three categories - small, midsize, and large - came later in the night. First to be recognized were organizations exemplifying specific traits. These "special awards" showcased traits like strength in leadership and business direction to training and benefits. 

MedOne received the Well-Being award for “Prioritizing employee well-being,” which is consistent with their #1 Core Value. Coupled with placement in the top ten, MedOne CEO Wes Hartig is humbled and proud of his team: 

When others ask what makes MedOne unique and successful, it’s our people.

Wes Hartig, CEO of MedOne

"Our people deliver outsized value to those we serve and make MedOne a fun and fulfilling place to work through living out our Core Values and recognizing their fellow teammates who do the same. Our people are the heart of this company and this Top Workplace in Iowa award goes to them."

The Top Workplaces awards and recognitions are based solely on employee feedback gathered through a third-party survey administered by employee engagement technology partner Energage, LLC. The confidential survey uniquely measures the employee experience and its component themes, including employees feeling Respected & Supported, Enabled to Grow, and Empowered to Execute, to name a few.

Attendees enjoyed a lively celebration with music from DJ Andy “Cubbie” Powell of Select Entertainment, along with food, drinks, and networking among Iowa’s best employers.

Formulary Management & New-to-Market Medications | MedOne News | MedOne - Pharmacy Benefit Solutions
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Formulary Management & New-to-Market Medications

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P&T Committee Reviews Q2 New-to-Market Drugs

As part of MedOne’s commitment to clinical excellence and cost-effective care, the Formulary Management Sub-Committee of our larger Pharmacy & Therapeutics (P&T) Committee met recently to evaluate newly FDA-approved medications that came to market in Q2. These quarterly meetings determine if and where these new-to-market medications would be placed within our formulary. 

This review process ensures that our clients and members have access to the most appropriate therapies, aligned with both clinical value and financial sustainability.

Outlined below is a sampling of some of the drugs that were reviewed and the corresponding commentary and tier placement. These drugs, while approved by the FDA, have had little time in the market, so it can be difficult to assess their efficacy as well as their financial impact. Therefore, the sub-committee can deploy a “New-to-Market Block.” When placed on a specific drug during review, this delays placement, requiring more data to be present before moving forward. This notation was deployed on the following: 

Tryptyr (acoltremon)

Approved on May 28, 2025, Tryptyr is an ophthalmic solution used to treat the signs and symptoms of dry eye disease. While it introduces a new mechanism of action, the committee opted to place it on formulary as a Non-Preferred Brand with a New-to-Market Block, allowing time to assess comparative effectiveness and member response.

Andembry (garadacimab-gxii)

Approved on June 16, 2025, Andembry is a once-monthly injection treatment designed to prevent attacks of hereditary angioedema (HAE), or painful swelling of the arms, legs, face, throat and abdomen. As an orphan drug, it offers a targeted solution for a rare but serious condition. The committee placed Andembry on formulary as a Non-Preferred Brand Specialty with a New-to-Market Block, allowing time for further evaluation of real-world outcomes and pricing dynamics.

Orphan Drugs

The orphan designation is awarded to drugs by the FDA alongside their approval. Orphan drugs treat rare diseases that affect a small percentage of the population, and there are often few to no treatment alternatives. While demand for these medications is typically low, the need (when it does arise) is urgent. As a result, these treatments tend to be very expensive and can place a significant financial burden on self-funded insurance plans. 

You may be aware that MedOne has an Orphan Drug Exclusion election built into our benefit specification form (BSF). This option to exclude certain orphan drugs allows for the prioritization of other treatments ahead of some of these therapies, protecting plan sponsor resources. Of course, if an orphan drug is deemed the best course of treatment for a member, this is evaluated in our clinical review process and addressed on a case-by-case basis. 

Several orphan drugs were up for discussion during this review session, including those outlined below. 

Avmapki Fakzynja Co-Pack (avutometinib + defactinib)

This combination therapy was approved on May 8, 2025, for the treatment of KRAS-mutated recurrent low-grade serous ovarian cancer (LGSOC) following prior systemic therapy. As an orphan drug, it addresses a niche but critical need in oncology. The committee placed it on formulary as a Non-Preferred Brand Specialty, recognizing its potential while maintaining cost oversight.

Ibtrozi (taletrectinib)

Ibtrozi received FDA approval on June 11, 2025, and is indicated for the treatment of locally advanced or metastatic ROS1-positive non-small cell lung cancer (NSCLC). This once-daily oral therapy is also designated as an orphan drug. Given its clinical relevance and specialized use case, it was added to formulary as a Non-Preferred Brand Specialty.

MedOne’s Formulary Management Approach

These were just four examples of how new-to-market medications can end up on formulary. Each medication is evaluated based on clinical efficacy, safety, cost-effectiveness, and alignment with MedOne’s mission to unlock the most appropriate prescription at the most affordable price. Our P&T Committee includes pharmacists, clinicians, and other intentional representatives who ensure that every formulary decision reflects our commitment to real results, real people, and real savings.

MedOne CEO Shares Stage with Mark Cuban | MedOne News | MedOne - Pharmacy Benefit Solutions
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MedOne CEO Shares Stage with Mark Cuban

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DUBUQUE, July 8, 2025 —  MedOne Pharmacy Benefit Solutions CEO Wes Hartig will share the stage with venture capitalist, businessman, and entrepreneur Mark Cuban. The co-founder of Mark Cuban Cost Plus Drug Company (MCCPDC) will participate in a panel discussion focused on employer solutions for controlling pharmacy costs tomorrow, July 9 at The Mint at Michigan First Conference Center north of Detroit. 

This event is aimed at helping self-funded employers prepare for the largest increases in employee benefit plan costs industry professionals have seen yet. The three key talking points that are slated are: 1) the "new horizon" or era of employer pharmacy cost, 2) aligning the supply chain including and 3) what the presenters are calling "game changer" or infusion & specialty cost containment solutions.

Cuban, through MCCPDC and his many relationships, is changing the game of pharmacy benefits by eliminating the many layers of revenue in employer’s supply chain and creating more transparency in the market.

In MedOne's 2024 Drug Trend Report published earlier this year, Cuban is quoted saying: “By partnering with MedOne, we can get affordable medications to more patients who need them. Healthcare shouldn’t be a black box where drug costs are hidden so that insurance companies can make money off of sick patients and American employers. Cost Plus Drugs is about making quality medications affordable and being transparent with our pricing. The partnership with MedOne aligns with our mission. Together, we’re giving people access to low-cost drugs without any hidden fees or surprises. It’s all about transparency and making a real difference in people’s lives.”

The topic of this event's presentation material is meant to further underline how employers can get the most appropriate prescriptions in the hands of their members at affordable prices, the overall mission of MedOne. 

 

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About MedOne Pharmacy Benefit Solutions

MedOne helps organizations and their health plan members conveniently access the most appropriate prescription at the most affordable price through its aligned and performance-based pharmacy benefit solution. MedOne’s offering focuses on enhancing the member’s pharmacy benefit experience, improving clinical outcomes, and reducing net cost for plan sponsors and their members. MedOne operates in all 50 states, and its customer base includes organizations of all sizes and across a variety of industries. MedOne is honored to be included in the 2024 Inc. Magazine’s 5000 fastest-growing private companies in America. For more information, visit www.medone-rx.com.

From a Pharmacist: Wear Sunscreen | MedOne News | MedOne - Pharmacy Benefit Solutions
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From a Pharmacist: Wear Sunscreen

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Summer is here and in full swing! With it comes ball games, swimming pools, hiking trails, golf courses, and all things outdoors. While it is often encouraged by healthcare professionals to get outside and enjoy some healthy exercise, it is imperative to protect yourself from the sun.  

Sunlight is our body's main source of vitamin D, which is essential for supporting strong bones, a healthy immune system, better mood, heart health, and muscle function. While sun exposure offers these benefits, too much sunlight can be harmful and do more damage than good.  

Sunlight is the primary source of ultraviolet (UV) radiation, a major risk factor for all skin cancers. There are two types of UV radiation that contribute to this risk: UVA and UVB rays. Fortunately, there are many ways to protect ourselves from harmful UV exposure. Effective protection methods include: staying in the shade, wearing long clothing to cover your skin, wearing sunglasses and hats to shield your eyes and face, and applying sunscreen to exposed areas of skin.  

Because both UVA and UVB rays increase the risk of skin cancers, it is important to choose a sunscreen with broad spectrum coverage to protect against both. When selecting a sun protection factor (SPF), the level of protection needed depends on the outdoor activity and how long you will be exposed to the sun. SPF 30 is ideal for everyday wear, while SPF 50 is better for extended outdoor activities such as swimming, outdoor sports, or working outside.  

The idea of all-day sunscreen coverage is a myth! Sunscreen should be reapplied at least every two hours and immediately after sweating or swimming. Even water-resistant sunscreen formulas will wash off eventually. Sunscreens labeled “water-resistant” should be reapplied after 40 minutes in the water, and sunscreens labeled “very water-resistant” should be reapplied after 80 minutes. Regardless of type, all sunscreen should be reapplied after toweling off.  

MedOne encourages everyone to prioritize their well-being. It's one of our Core Values! One great way to do this is by getting outside and enjoying the summer season… just don’t forget to pack your sunscreen!  

 

-Claire H.  
PharmD Candidate 
University of Iowa College of Pharmacy  - Class of 2026 

MedOne Releases 2024 Drug Trend Report | MedOne News | MedOne - Pharmacy Benefit Solutions
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MedOne Releases 2024 Drug Trend Report

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MedOne Releases 2024 Drug Trend Report Focused on Health Outcomes, Lowered Net Cost, and Customer Experience

MedOne Pharmacy Benefit Solutions, a full-service, transparent pharmacy benefit manager (PBM), is proud to announce the release of its inaugural 2024 Drug Trend Report, offering a data-driven, transparent look into the evolving pharmacy benefit landscape. This report includes data and metrics from MedOne's book of business, claims data, and financials, identifying key trends in spend and utilization. Analysis has been conducted and framed using the lens of MedOne's own proprietary scoring system, The MedONE Score, focusing on 1) health outcomes, 2) net cost, and 3) customer experience as it explores 2024 trends. 

“MedOne has established a reputation as the 'best kept secret' in PBM, and now the secret is out,” said Dr. Nate Harold, PharmD, RPh., Chief Pharmacy Officer at MedOne. “For 25 years MedOne has been at the forefront of price transparency, improving outcomes, and providing unmatched customer service. In 1999 we set out to do the right things for the right reasons, and we are excited to show you what happens when those principles guide you."

In 1999 we set out to do the right things for the right reasons, and we are excited to show you what happens when those principles guide you.

Dr. Nate Harold, PharmD, RPh., Chief Pharmacy Officer

The report highlights key trends impacting prescription benefits throughout 2024. Setting the stage as part of the report’s "key insights" is an impressive $67.39 net per member per month (PMPM) spend for 2024; a 0.04% year-over-year increase in prescription spend trend; and a 673% increase in membership since 2018. When compared against industry benchmarks, this result is 43.5% lower than the industry net PMPM spend average.

The report identifies increased utilization of specialty medications, consistent with the rise of new specialty medications approved in the U.S. market. This correlates with an average net PMPM spend of $24.13 in the specialty medications category, which is approximately a 3% decrease year-over-year. New biosimilar and generic options, as well as increased use of cost-plus pharmacies, helped reduce cost while more patients accessed specialty treatments.

MedOne's utilization management strategies can objectively be deemed successful; clinical outcomes are analyzed throughout the report, depicting positive results for patients when measured against nationally accepted benchmarks. For example, 2024 data reflects an improved percentage of members at goal on treatment for chronic conditions like diabetes, rheumatoid arthritis, and multiple sclerosis.

Outlining different cost containment strategies and successes, MedOne's 2024 Drug Trend Report returns to the recurring theme of customer experience, even stating: “If not for our patients, then why would we exist.” Statements of support from clients and members of MedOne benefit plans alike speak to the focus MedOne places on enhanced customer experience. One testimonial is from Phillip Blair, the Vice President of Human Resources at Gamber-Johnson, an organization recognized as the #1 Healthiest Workplace in Wisconsin and the #15 in the United States according to Healthiest Employers®, in partnership with Springbuk. He shares: "Our partnership with MedOne has been instrumental in aligning pharmacy benefit strategies with meaningful health outcomes. By leveraging MedOne’s integrated solutions and proactive approach, we’re not just managing costs—we’re making strategic investments that truly improve the health and well-being of our members.”

Several instances in which members were given the opportunity to provide feedback on their experience with MedOne are represented in the report. With concerted effort to measure and enhance the member experience, MedOne has achieved a 4.6/5 Google rating and 4.8/5 member satisfaction score based on internal survey results.

In addition to the key trends detailed in the report, MedOne outlines additional market changes that have had a significant impact on the prescription benefit landscape. The report concludes with a look-ahead commentary on what the anticipated drug trends are set to impact plans in the coming year.

 

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About MedOne Pharmacy Benefit Solutions

MedOne helps organizations and their health plan members conveniently access the most appropriate prescription at the most affordable price through its aligned and performance-based pharmacy benefit solution. MedOne’s offering focuses on enhancing the member’s pharmacy benefit experience, improving clinical outcomes, and reducing net cost for plan sponsors and their members. MedOne operates in all 50 states, and its customer base includes organizations of all sizes and across a variety of industries. MedOne is honored to be included in the 2024 Inc. Magazine’s 5000 fastest-growing private companies in America. For more information, visit www.medone-rx.com.

5 Trends for PBM in 2025 | MedOne News | MedOne - Pharmacy Benefit Solutions
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5 Trends for PBM in 2025

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The pharmacy benefit landscape is evolving rapidly, and 2025 is proving to be a pivotal year. Rising drug costs, increased demand for transparency, and the emergence of new therapies are pushing plan sponsors to rethink how they manage their pharmacy benefit. At MedOne, we’ve identified the following five key trends that are reshaping the PBM space and what they mean for your organization. 

1. Active Management: The End of “Set It & Forget It”

Gone are the days when pharmacy benefits could be placed on autopilot. Today’s environment demands a hands-on, data-driven approach. Plan sponsors must work closely with their brokers and PBMs to continuously evaluate claims data, identify cost drivers, and implement strategies that align with their organizational goals. 

This doesn’t mean a one-size-fits-all solution. Every organization has unique needs, and success depends on tailoring benefit strategies accordingly. Whether it’s adjusting formulary design, implementing utilization management tools, or exploring alternative funding models, proactive management is essential for long-term sustainability. 

2. Visibility & Transparency: Your Data, Your Way

The foundation of any effective pharmacy benefit strategy is access to data. Without it, plan sponsors are flying blind. That’s why “transparency” is more than a buzzword. It’s a necessity. 

At MedOne, we believe in “Your Data, Your Way.” Plan sponsors should have full access to their claims data in formats that are easy to analyze and act upon. But transparency doesn’t stop at data access. Understanding how your PBM earns revenue—whether through spread pricing, rebate retention, or other mechanisms—is critical. These financial incentives can influence formulary decisions and ultimately impact member health outcomes. 

The goal? Align PBM incentives with what truly matters: better health outcomes, lower net costs, and a high-touch, high quality member experience. 

3. GLP-1 Strategy: Balancing Access & Oversight

GLP-1 medications, originally developed for diabetes, have surged in popularity due to their effectiveness in weight management. But with high demand comes high cost, and plan sponsors are feeling the pressure. 

Most PBMs now require prior authorization (PA) for GLP-1s, but not all criteria is created equal. It’s vital to understand how these drugs are being covered and why they’re driving spend. If your plan covers GLP-1s for weight loss, consider pairing that coverage with a wellness program. MedOne partners with Tria Health to ensure members are set up for long-term success. These medications are most effective when combined with routine changes, member support, nutritional counseling, and lifestyle coaching. 

4. Biosimilars: A New Era of Savings

The biosimilar market is gaining momentum, and 2025 is a breakout year. With blockbuster drugs like Humira and Stelara losing patent protection, plan sponsors have a golden opportunity to reduce costs through the use of biosimilars.  

New-to-market medications like Yusimry and Otulfi offer lower net costs without compromising clinical outcomes. But success depends on agility. PBMs must be able to pivot quickly, update formularies, and guide members through transitions seamlessly. 

At MedOne, we take a hands-on approach to biosimilar adoption, ensuring a smooth member experience that prioritizes maximum savings. And with more high-cost drugs set to go off-patent, this trend is just beginning. 

5. Net Cost Focus: Looking Beyond the Rebate

Rebates have long been a focal point in pharmacy benefit discussions, but they don’t tell the whole story. A high rebate on an overpriced drug isn’t a win if that drug shouldn’t have been on the plan in the first place. 

That’s why we encourage plan sponsors to focus on net cost, the true bottom line after accounting for discounts, rebates, and administrative fees. A net cost approach ensures every dollar is spent wisely, avoiding short-term illusions of savings and promoting long-term plan sustainability. 

2025 is a year of transformation in PBM. From embracing biosimilars to rethinking GLP-1 coverage, plan sponsors have more tools—and more responsibility—than ever before. The common thread across all five trends? Intentionality. Success in today’s pharmacy benefit landscape requires active engagement, transparency, and a relentless focus on value. 

At MedOne, we’re here to help you navigate this evolving landscape with clarity and confidence. Talk with a member of our team to learn more: info@medone-rx.com.  

Proposed Changes to the PBM Landscape: The MedOne Take | MedOne News | MedOne - Pharmacy Benefit Solutions
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Proposed Changes to the PBM Landscape: The MedOne Take

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The regulatory landscape of pharmacy benefits is hot with activity. When asked about our views on PBM reform and whether we are for or against it, we assess from the viewpoint of whether it is good for: 1) the public, 2) plan sponsors, and 3) MedOne.  

There are two primary happenings MedOne is closely following: SF 383 (the Iowa PBM) bill currently under review by Governor Reynolds and the Executive Order released from the White House earlier this week titled “Delivering Most-Favored-Nation Prescription Drug Pricing To American Patients.” 

Here’s what you need to know: 

SF 383 (Iowa PBM) Bill:

Iowa’s PBM reform bill, heavily backed by the Iowa Pharmacy Association, targets and aims to combat discriminatory PBM practices, restore patient choice, and enforce adequate reimbursement to Iowa pharmacies.  

In general, MedOne is supportive of this bill as it bans spread pricing and requires 100% pass-through pricing of discounts and rebates. This bill also requires that retail pharmacies are paid a minimum reimbursement of NADAC (publicly available benchmark reflecting the average pharmacy’s acquisition cost for drugs) + a $10.68 dispense fee. Many competitors critique this provision, indicating it will lead to an increase in cost for Iowans and Iowa employers.  

When we look at our data, we see a very different picture and are not concerned; it instead showcases a win-win-win: Lower prices for Iowans and our clients, better reimbursement for independent pharmacies, and neutral to MedOne since we don’t generate revenue based on what we reimburse pharmacies. 

While we may not fully support each element of SF 383 (we view requiring copay coupons to track toward deductibles and out-of-pocket maximums as a negative for our clients), this bill is a step in the right direction, and MedOne is ready to help Iowa employers navigate and embrace this positive change.  

Regarding the Executive Order (EO):

The general goal of the EO is ensure pharmaceutical manufacturers are offering a “most-favored-nation price” to Americans; in other words, as good as the lowest price offered in any other country, which is not the case today. The opening lines of the EO state: "The United States has less than five percent of the world’s population and yet funds around three-quarters of global pharmaceutical profits." Going on to describe this as "egregious," as the U.S. as an "unwitting sponsor," and this practice as a whole as "abuse of the Americans' generosity." This sets the stage for a targeted and toothy path forward.  

It appears many of the action items emerging from this order will fall to the Health and Human Services Secretary as the primary lead. Tasked with communicating the most-favored-nation price targets to pharmaceutical manufacturers within 30 days of May 12, we look forward to seeing these targets take shape.  

Should this prove unattainable, the Secretary is then tasked with proposing rulemaking that would (make it mandatory, not voluntary to) formally allow drug importation from developed nations with low-cost prescriptions, and/or other steps to penalize noncompliance. We expect pharmaceutical manufacturers to push back, but it is worth noting that this EO gives the Administration a path forward (in addition to significant threats). We are optimistic as it seems this effort is intended to address all Americans (not just Medicare and Medicaid programs) and would lead to lower net prices for our clients and members, alongside broader access with more pricing parity and greater simplicity for the average American. 

At this point in time, regarding both cases, we wait and we hope for more  transparent and affordable prescription drug prices for all. 

MedOne’s continued focus for our clients and members:

For over 25 years, MedOne has charged transparent fees for our services that we must (and do) justify in how we help our clients manage spend, care for their members, and deliver quality service. Our business model is incredibly simple, yet effective: 

   ▪️   Charge a transparent, aligned Per Member Per Month (PMPM) administrative fee where our revenue is not driven by increasing spend. 

   ▪️   Ensure appropriate use of prescriptions so you “pay for the right things" opposed to “pay for everything” or “pay for nothing.” 

   ▪️   Extend our single and best price for prescriptions to ALL clients without adjustment, while embracing innovators who can deliver even lower prices. 

   ▪️   Support members in their journey to conveniently access the most appropriate prescription at the most affordable price. 

Our business model has delivered proven results for our clients and is well-positioned for continued change across the pharmacy landscape. In fact, we welcome these types of changes when they benefit our members and clients. 

We will continue to monitor the regulatory landscape and provide material updates as they are available. If you have any questions, please contact your Account Manager.

MMR Vaccine | MedOne News | MedOne - Pharmacy Benefit Solutions
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MMR Vaccine

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1,024 cases of measles have been confirmed in the US as of May 15, 2025. Given this rise, we’ve fielded lots of questions about the virus and the Measles, Mumps and Rubella (MMR) vaccine. Let’s dig into this topic a bit further!

We’ll first start with the confirmed cases, the cases are equally spread amongst all age groups (under 5 years of age, 5-19 years of age, and 20 years and older), with the majority of the cases, 97%, reporting either an unvaccinated or unknown vaccination status. Out of all the cases, there is only one confirmed death and 1 other under investigation. It’s important to keep in mind that the US currently has 340.1 million people, so 607 confirmed cases are less than 1% of the population. 

Measles is a high contagious viral illness that starts with a fever, cough, fatigue and runny nose, within 7-14 days after exposure small white spots with bluish-white centers will appear inside the mouth on the cheek. These are called Koplik’s Spots. People who suspect they have been exposed to the measles should contact their healthcare provider or an urgent care center immediately for care. 

In 1963 the first measles vaccine was licensed for use in the US and was the first significant step in measles protection. Patients who were born before 1957 are generally considered to have a natural immunity to measles as most children contracted it and have formed a life-long immunity to it before that time.  In 1989, an outbreak of the measles among school-aged children prompted a recommendation for a second dose of MMR vaccine for all children, which led to a further decline in reported cases, with the US declaring an elimination of measles in 2000 (an absence of the continuous spread for greater than 12 months). 

The MMR vaccine is currently recommended to be given 2 doses of the vaccine with the first dose between the age of 12-15 months, and the second dose between 4 and 6 years old. Older children, adolescents and adults should only receive additional doses of the MMR if they do not have evidence of immunity. This evidence would be in the form of a laboratory titer test. Titer tests are blood tests that check for the presence of antibodies which indicate immunity to, in this case, the measles. This immunity can be either from a vaccination or from a past infection. 

The CDC further explains that only people at increased risk during an outbreak should receive an additional dose of the MMR, and those people will be notified by public health authorities. 

Further take aways include that no booster vaccine is recommended at this time, with the CDC stating that “people who received two doses of measles vaccine as children according to the U.S. vaccination schedule protected for life, and they do not ever need a booster dose”. 

Finally, remember that good hand hygiene, staying home when sick, cleaning surfaces regularly, and overall good nutrition and rest can help keep you safe from any virus, including measles, mumps, and rubella! 

The MedOne Biosimilar Strategy: Stelara® | MedOne News | MedOne - Pharmacy Benefit Solutions
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The MedOne Biosimilar Strategy: Stelara®

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MedOne is excited to announce the newest iteration of our Biosimilar Strategy! Effective April 4, 2025, MedOne will be preferring Otulfi®, as it is the lowest net cost biosimilar for the reference product Stelara.

This change is set to bring substantial savings, reducing costs by an impressive 96% (when compared to the list price of Stelara) for our clients and members who have been previously utilizing Stelara to treat Crohn's disease, ulcerative colitis, plaque psoriasis, or psoriatic arthritis. 

Through our partnership with ​Mark Cuban Cost Plus Drug Company (MCCPDC), the cost of treatment using Otulfi will be between $4,000-6,000 annually compared to other treatments that cost $40,000+ annually. 

Strategy Details


This shift will operate similarly to our Humira-to-Yusimry iteration of the Biosimilar Strategy. Otulfi will be placed on our T0 specialty list, like Yusimry, allowing plans that exclude specialty medications access to this cost-effective biosimilar.

Stelara will be removed from the PAP-eligible list. This change comes as Johnson & Johnson (J&J) has removed Stelara from their list of eligible drugs for manufacturer assistance. Current members utilizing the J&J Foundation will continue to access Stelara through the Foundation until no longer eligible. Upon notification that a member no longer is accessing Stelara through the J&J Foundation, the member will be transitioned to Otulfi and fill at MCCPDC. 

Like Yusimry, indication-based exclusions will still apply. 

Effective immediately, Stelara will no longer be included in our international sourcing program. The price to access Brand Stelara internationally exceeds the cost to fill Otulfi at Cost-Plus Drugs. The PCC team will work to transition patients to filling Otulfi domestically.  

All-in-all, this iteration of our biosimilar strategy supports our overall mission: To provide members with access to the most appropriate prescription at the most affordable cost.

About Biosimilars

Biosimilars are a type of biologic medication that are safe and effective. Biosimilars are medications aimed to replicate the therapeutic safety and efficacy of medications already licensed in the market, which are termed as “reference products” by the Food and Drug Administration (FDA). When biosimilars are considered for market approval by the FDA, the main ingredient structure must be identical to the reference product, but the inactive ingredients (or “excipients”) may differ.

Because of this requirement, a biosimilar and its original biologic have the same treatment benefits and risks. They must also: 

  • Be administered in the same way
  • Have the same strength and dosage form
  • Have the same potential side effects

Because biosimilars are developed by different manufacturers from the manufacturer who produces the reference product, the result is competitive pricing of these already high-cost biologic medications, thus increasing access and coverage affordability for patients and payors. All the while, maintaining clinically effective treatments.

If you have any questions about biosimilars, the newest iteration of this strategy, or anything else relating to your pharmacy benefit, please reach out to your MedOne Account Team. 

The Shifting Tide of GLP-1s | MedOne News | MedOne - Pharmacy Benefit Solutions
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The Shifting Tide of GLP-1s

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The drug class that's taking the world by storm is finally seeing generic alternatives enter the market. From their high costs to their weight loss effects, GLP-1s seem to be what everyone is talking about. And a shift in tide – and price tags – is upon us. 

In December of 2024, the FDA approved the first generic GLP-1, a version of Victoza® (liraglutide injection) for treating type 2 diabetes ages 10 and older. While GLP-1s rose in popularity due to their weight loss effects, this medication, and several others in this class are approved exclusively for the treatment of diabetes, a disease that affects over 11% of the US population. This means high costs for appropriate treatments for our members. Until now. 

“With the accessibility of generic liraglutide, MedOne members will have access to efficacious medication for the treatment of Type 2 Diabetes Mellitus at a lower cost, which could remove financial barriers to care for patients,” said Dr. Katrina Morgan, Director of Clinical Review.

With the accessibility of generic liraglutide, MedOne members will have access to efficacious medication for the treatment of Type 2 Diabetes Mellitus at a lower cost, which could remove financial barriers to care for patients.

Dr. Katrina Morgan, Director of Clinical Review

The availability of generic liraglutide will help drive down costs by reducing total spend on medications, in this case specifically in the GLP-1 receptor agonist bucket. Currently, GLP-1s indicated for the treatment of type 2 diabetes contribute to over 16% of total spend across the MedOne book of business. With generic prescriptions accounting for 90% of prescriptions filled but only 17.5% of prescription drug spend (2023 U.S. Generic & Biosimilar Medicines Savings Report complied by IQVIA), this could add up to major savings for payors.

A generic drug is a medication that is identical to a brand-name drug in terms of active ingredient, strength, dosage form, and route of administration. Brand drugs generally hold a patent for 20 years, which prohibits other companies from manufacturing and selling generics of the medication until the patent is lifted. Generic medications generally are less expensive than brand-name drugs because they do not require the same research and marketing costs. Generic drugs are manufactured to the same quality standards as brand-name drugs and must undergo rigorous testing to ensure their safety and effectiveness. While generic drugs have the same active ingredient, they may have different inactive ingredients, such as fillers, colors, or preservatives. However, this does not affect the therapeutic effect of the drug.

MedOne has been closely watching the development and availability of generic liraglutide and other research in this space. As additional organizations begin to manufacture generics like this, we anticipate significant changes in price. If and when this generic becomes the lowest net cost option, MedOne will announce corresponding formulary changes. 

MedOne and Brightn Launch Innovative Partnership to Address Growing Mental Health Crisis in Iowa | MedOne News | MedOne - Pharmacy Benefit Solutions
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MedOne and Brightn Launch Innovative Partnership to Address Growing Mental Health Crisis in Iowa

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With the mental health challenges today's workforce faces on the rise, MedOne has partnered with Brightn to provide comprehensive mental wellness support for employees and their families across their book of business. This strategic alliance comes at a crucial time, as recent data shows 77% of U.S. workers report experiencing at least one symptom of a mental health condition, with 84% citing workplace conditions as a contributing factor.

MedOne’s clinical team has kept a close eye on this growing mental health crisis as it relates to the pharmacy claims MedOne process on behalf of their self-funded employer groups. Senior Clinical Program Manager Shelby Jones saw the need for additional support for MedOne's members and began the search for an innovative partner in the space to pioneer the Behavioral Care Path offering. 

“Mental health is very important to me,” said Jones. “This offering is the perfect complement to our program supporting mental health wellness. I’ve always been an advocate for mental health services, and I’m excited to bring this unique approach to MedOne’s members.”

Plan sponsors can elect to offer the Behavioral Care Path program. Once elected, there is a two-pronged approach designed to support patients who are seeking support for mental health disorders. 

This first part of the Behavioral Care Path targets members on medications for mental health and ensures those prescriptions are the right medication for that specific member and the state of their mental health. 

MedOne's processes use historical claims data to identify a variety of drug-therapy problems and care plans in order to help members reach their mental health care goals as quickly as possible. Drug-drug interactions, duplications of therapy, and medication non-compliance are common amongst mental health treatments. This care path identifies these disruptions in the treatment plan, and recommendations are sent to prescribers to reduce the serious risk of adverse events. Most mental health medications take 8-12 weeks to demonstrate full effectiveness and patients often have to try 3-4 medications before achieving results. The goal is to get the right medication in the hands of our members as quickly as possible so they can be at their best. 

The second part of Behavioral Care Path targets members who struggle or otherwise want to improve or prioritize their mental health and well-being. Enter Brightn. 

"Recent Harvard studies show that 88% of Americans are metabolically unhealthy, 75% lack clear meaning and purpose, and 77% live paycheck to paycheck," said Jeffrey Johnston, CEO and Founder of Brightn. “These interconnected challenges led us to develop a comprehensive approach focusing on health, wealth, and purpose. After losing both my son and wife to mental health-related struggles, I understand firsthand the critical importance of preventative mental wellness support."

Our goal is to empower individuals to transform their mental health and build a brighter future.

Jeffrey Johnston, CEO & Founder of Brightn

Brightn's approach is to make weekly mental health planning straightforward and effective, helping patients integrate lifestyle improvements seamlessly into their daily life. Through the AI-powered app, customized programming is designed to enhance mental wellness through personalized challenges, mood tracking, and journaling. Access to the app and all its features, progress tracking, and community and peer support are all accessible to MedOne members through the Behavioral Care Path. 

MedOne's own employees and their families are among the pilot participants who are testing the care path offering. These members will receive free access to Brightn's premium platform, which has demonstrated remarkable results - 60% of users report significant improvements in their wellness outcomes after just 30 days of consistent engagement.

"One in eight people globally have a mental health disorder, which means everyone on our team likely knows someone affected by mental health challenges," said Wes Hartig, CEO at MedOne. "As an employer, we want to be proactive in supporting our employees' well-being - it's our number one core value. This partnership with Brightn aligns perfectly with our commitment to supporting the full picture of well-being: physical, mental, and spiritual."

The partnership represents a significant advancement in corporate mental wellness support, combining MedOne's healthcare expertise with Brightn's innovative technology. Both organizations share Iowa roots and Midwest values, creating a strong foundation for this collaborative effort to support local communities.

"This partnership exemplifies MedOne's commitment to innovative healthcare solutions," added Hartig. "Working with a fellow Iowa-based company allows us to be responsive to our employees' needs while supporting local innovation in healthcare technology."

About Brightn

Founded in Cedar Rapids, Iowa, Brightn is transforming mental wellness support through AI-powered technology and personalized planning. The platform focuses on making mental wellness as routine as brushing your teeth, helping users achieve balance in health, wealth, and purpose. Early results show that members who engage with the platform for more than 30 days experience a 60% increase in positive outcomes through the platform's comprehensive tracking metrics. Download the Brightn app today by visiting www.brightn.app

Media contacts:

Emilie Mauricio
Emilie@brightnapp.com

Expedited Access to Stelara® Biosimilars for MedOne Members | MedOne News | MedOne - Pharmacy Benefit Solutions
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Expedited Access to Stelara® Biosimilars for MedOne Members

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MedOne Pharmacy Benefit Solutions, a full-service pharmacy benefit manager, has put parameters in place to grant access to newly approved biosimilars as soon as they come to market. 

The much-anticipated biosimilars for ustekinumab, commonly known by its brand name Stelara®, are set to hit the market in mid-2025. True to MedOne’s commitment to ensuring access for their members to the most appropriate prescription at the most affordable cost, MedOne has added four low-WAC biosimilars to its formulary.

Our clients and patients do not have to wait months, or even years, to use these new cost-effective alternatives, "

said Chief Pharmacy Officer Dr. Nathan Harold.

Dr. Harold goes on to say, "Since MedOne manages their formularies in-house, we are able to do something few can; we added low-cost Stelara biosimilars to formulary, and these will be available to patients as soon as they are stocked in pharmacies.”

The four biosimilars that have been added to formulary at the time of publication are Otulfi, Steqeyma, Yesintek, and Wezlana, the lowest of which coming in at a price point 90% less than the currently available brand name medication.

“The most exciting part is as cost comes down, we are able to better ensure more access to care which will improve clinical outcomes while being the best possible steward of our clients’ financial resources,” said Dr. Harold. This medication is commonly prescribed for Crohn's disease, ulcerative colitis, plaque psoriasis, and psoriatic arthritis, disease states which collectively affect 10.1 million Americans. 

To date, MedOne’s biosimilar strategy has delivered a 90%+ conversion rate to the lowest net cost biosimilar. This newest iteration of this strategy expects to deliver similar results for our clients and members.

From Core Values to Cost Savings: A look at how MedOne cut pharmacy spend in half for Midwest manufacturer | MedOne News | MedOne - Pharmacy Benefit Solutions
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From Core Values to Cost Savings: A look at how MedOne cut pharmacy spend in half for Midwest manufacturer

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From Core Values to Cost Savings

A look at how MedOne cut pharmacy spend in half for Midwest manufacturer. Below is an overview, followed by an explanation of how MedOne successfully overcame the challenges.

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Introduction

Gamber-Johnson, a leading manufacturer of rugged mounting systems, faced significant challenges managing and controlling their pharmacy spend. Rising specialty drug costs, inflexible programs, and limited collaboration with their pharmacy benefit manager (PBM) were driving up expenses while frustrating their team and members.

They turned to their broker partner M3 Insurance, a Midwest-based top insurance broker and risk management firm in search of a solution. At the recommendation of their M3 representative, Gamber-Johnson partnered with MedOne—a full-service pharmacy benefit manager focused on transparency, innovation, and actionable cost containment strategies. This partnership not only met but exceeded expectations, delivering substantial cost savings, improved member outcomes, and unparalleled customer service.

Since making the move to MedOne, Gamber-Johnson was named the #1 Healthiest Workplace in Wisconsin and the #15 in the United States according to Healthiest Employers®, in partnership with Springbuk.

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Before transitioning to MedOne, Gamber-Johnson encountered numerous roadblocks that hindered cost management and member satisfaction. These included: 1) formulary misalignment, 2) inflexibility and lack of innovation, and 3) high specialty drug costs. Phillip Blair, the vice president of human resources at Gamber-Johnson, noticed these patterns in the claims data and grew frustrated with the lack of actionable solutions.

Formulary Misalignment

For Gamber-Johnson, the previous PBM’s approach to formulary management often favored more expensive products, resulting in unnecessary spending.

“When we ran into some with the change in formulary… we would take a look at what the preferred medication with MedOne was versus the preferred medication with [the previous PBM], and they obviously had different methodologies,” said Blair.

Gamber-Johnson found that, when comparing the formularies of MedOne and their previous PBM, the previous PBM’s formulary contained higher-cost medications, often accompanied by high rebates. Based on the traditional model on which the previous PBM operated, these rebates were then retained by that PBM whereas with MedOne’s pass-through model, those rebates would have been routed to Gamber-Johnson. Not only was Gamber-Johnson paying more for on-formulary drugs, they were not awarded the rebates they earned, based on their utilization.

High Specialty Drug Costs

Specialty medications are a rapidly growing category of spend, driving overall prescription spend upwards. The presence of specialty drugs in a claims file is not an issue on its own; the high costs often associated with them, however, is where issues arise. Gamber-Johnson’s utilization featured a handful of specialty claims that were burdening the plan.

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When Gamber-Johnson met with MedOne, it became clear that MedOne’s approach aligned seamlessly with their goals. MedOne’s pass-through and fully-transparent model, combined with a focus on proprietary and actional cost containment strategies, appealed to Gamber-Johnson’s objectives.

Mindy Peterson, a business insurance associate at M3 and lead point of contact for Gamber-Johnson, described MedOne as “proactive, transparent, and member-centered.” Administering a pharmacy benefit is more than dollars and cents. She spoke about her decision to bring MedOne into the conversation: “Knowing what Phil wanted to do and what the future strategy looked like, the core values really aligned; it was a great fit.”

When MedOne speaks about alignment, the conversation goes beyond the world of pharmacy spend. True alignment goes deeper, into the mission, vision, and values of an organization. MedOne for example believes in helping people access the most appropriate prescription at the most affordable price, and core values include 1) prioritizing the well-being of employees, 2) striving to exceed client expectations, and 3) creating and embracing positive change. Pairing up with Gamber-Johnson, the synergy is obvious.

The guiding principles at Gamber-Johnson speak to the importance of generating “joyful growth.” This concept prioritizes the people at the heart of Gamber-Johnson alongside the importance they place on innovative products and operating under impeccable standards. This shared vision spoke to both the M3 and Gamber-Johnson teams, and ultimately invited MedOne to the table.

MedOne met with Gamber-Johnson in the fall of 2023 to discuss a new pharmacy benefit strategy. After sharing about MedOne’s roots in pharmacy and their unique approach to the marketplace, the conversation turned to the pain points Blair and his team were experiencing with the incumbent PBM. This initial touchpoint hammered out the cost-containment & access strategies MedOne would later implement for Gamber-Johnson, outlining MedOne’s depth and expertise. Blair recalled: “The level of conversation was way more than any conversation we had with the previous PBM… We walked out of that meeting and said, ‘Yes, we can move forward.’”

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MedOne’s customer service stood out from the start. Gamber-Johnson’s account is serviced by Chief Pharmacy Officer Dr. Nathan Harold, Director of Account Management Danielle Barton, and Senior Account Manager Whitley Johll. This three-pronged service approach ensures MedOne clients have access to the resources and expertise they need around the clock.  Early in the relationship, Blair recalled that “Danielle and Whitley were phenomenal. They answered every question I had really, really quickly.“

MedOne’s commitment to transparency and proactive service has been key to Gamber-Johnson’s success. MedOne regularly dialogues with both the Gamber-Johnson and the M3 teams sharing insight on up-and-coming industry trends, legislation changes, new cost-saving programs or opportunities, and other relevant topics.

“We’re talking to the MedOne team all the time. When member issues pop up, whether we need to switch drugs or whatever the case may be, it is a partnership.”

At the core, it is about making sure that the member is taken care of versus what kickbacks they’re going to get at the end of the day,”

said Peterson.

For example, a new Gamber-Johnson employee approached Blair expressing an interest in enrolling in the Gamber-Johnson plan but also a concern about a costly medication the employee was on. Blair relayed this information to MedOne to see how the prescription would be handled on the plan.

MedOne ran some test claims and relayed their findings to the Gamber-Johnson team. Per the plan design, the medication in question would not be covered but MedOne provides some additional options the member could explore to obtain their medication. The ensuing conversation was an overall positive one, due to MedOne’s transparent and proactive approach. The member ultimately made the decision to stay on the spouse’s plan. “A new hire hearing their medication was not going to be covered has the potential to be a really hard conversation. We gave them so much information and several different routes they could go down if they were to come to us, and they were happy.”

Consistent and thorough collaboration is key in these situations, and MedOne ensures frequent touchpoints to address questions and provide solutions.

Financial Alignment

MedOne focuses on driving to the lowest net cost for both the plan and the member while maintaining a high standard of care. A large sticking point with the previous PBM revolved around formulary structure and their capture of rebates.

This misalignment in formulary structure can be explained by looking at blood glucose monitoring systems for diabetics. These systems are often viewed as a black-and-white example in pharmacy; the system is either reading the levels and providing an accurate result or not.

The previously preferred monitoring device was a brand-name system costing between $8,252.20-$8,832.20 annually. As this was the preferred system on the previous plan, this drove costs for both the Gamber-Johnson plans and members up, compared to more affordable alternatives like MedOne’s preferred option.

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In this apples-to-apples comparison, MedOne’s preferred system is 2-3 times less than the previous PBM’s. Even with just a small number of claimants utilizing a blood-glucose monitor, the switch to MedOne’s preferred monitor would result in significant savings. The next step was simply to notify members of the upcoming change.

Diabetic members of the Gamber-Johnson prescription health plan were alerted via letter that the new plan, effective January 1, 2024, included a different preferred monitoring system. Disruption is to be expected when making any sort of plan change. It was the proactive communication that ensured a smooth transition of the members to the new device.

“Despite having a pretty drastic change from our previous PBM with a very large formulary – and we still have a very large formulary today – I think we have gotten equal if not better reviews with MedOne,” said Blair.

Innovative Programs

“When meeting with MedOne, what stood out to me was the fact that MedOne has so many of the levers, if not all of the levers, available within their existing structure. We didn’t have to go out and piecemeal all these different things to make an ultimate, better benefit for our team members.”

MedOne’s specialty cost containment strategies delivered dramatic savings for Gamber-Johnson upon implementation. Major pain points with the previous PBM centered on a small number of specialty claims. Knowing this, MedOne encouraged Gamber-Johnson to enroll in MedOne’s RxAlly program, their proprietary suite of specialty cost containment solutions.

While reviewing the claims experience, MedOne’s team of Patient Care Coordinators identified which of the strategies would result in the most savings for Gamber-Johnson and their members.

A handful of members were identified. One of the claims was for a medically necessary brand-name medication for Crohn’s disease. MedOne identified this prescription would be more affordable for both the plan and the member when sourced internationally.

Per the plan’s PPO plan, this member is able to access the medication at a $0 copay. Despite there being no member cost share, the plan still comes out ahead and still captures the rebate per MedOne’s pass-through model. Overall, by leveraging MedOne’s network of international pharmacies, the plan is saving almost $84,000 annually, on this one member alone.

The use of these targeted strategies and upfront communication was the key to such a significant decrease in overall pharmacy spend for the plan.

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Since entering into the partnership with MedOne, Gamber-Johnson has experienced the following savings:

Annual pharmacy spend prior to moving to MedOne was roughly $326,000. It is now in the ballpark $222,000. This moves the per-member-per-month (PMPM) costs from $103 PMPM to $46 PMPM.

It’s important to note, too, that these savings are in spite of an uptick in member count; Membership increased from 264 to 384 members during the first year of the service agreement with MedOne, yet total spend still dropped by over $100,000.

At the end of 2024, Gamber-Johnson spent:

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MedOne’s proactive management and innovative solutions ensured members received the medications they needed while identifying opportunities for cost savings.

Blair and his team experienced open, ongoing communication with MedOne, ensuring alignment on benefit strategies and rapid resolution of issues. “Everything is answered within 24 hours. I have all the information I need,” said Blair.

Conclusion

MedOne’s partnership with Gamber-Johnson exemplifies the value of a proactive, aligned transparent, and flexible PBM. By aligning on core values and implementing strategies tailored to Gamber-Johnson’s needs, MedOne delivers a significant net cost reduction, improved health outcomes, and a level of service unmatched in the industry.

Gamber-Johnson’s success demonstrates that MedOne is more than just a PBM—it is a strategic, key partner in achieving sustainable, member-centered pharmacy benefit solutions.

MedOne Promotes Dr. Nathan Harold to Chief Pharmacy Officer | MedOne News | MedOne - Pharmacy Benefit Solutions
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MedOne Promotes Dr. Nathan Harold to Chief Pharmacy Officer

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MedOne Pharmacy Benefit Solutions, a full-service pharmacy benefit manager, is pleased to announce the promotion of Dr. Nathan (Nate) Harold to Chief Pharmacy Officer (CPO). 

"For over a decade, Nate Harold has been a cornerstone of MedOne's remarkable journey," said Wes Hartig, CEO of MedOne. 

His leadership and relentless drive for improvement has propelled our growth and success."

Wes Hartig, CEO of MedOne

With over 15 years of experience in the pharmacy and healthcare industry, Dr. Harold brings a wealth of knowledge and a forward-thinking approach to his new role as Chief Pharmacy Officer. Dr. Harold will continue to oversee all Clinical and Pharmacy Services, as well as Strategic Pricing moving forward. His experience in growing and leading teams as well as his unique leadership approach will no doubt contribute to the continued overall growth of MedOne. 

Dr. Harold joined MedOne on June 23, 2014 as MedOne’s first Clinical Pharmacy Manager. He was soon thereafter promoted to VP of Clinical Services where, in his tenure, he spearheaded numerous initiatives that have elevated MedOne’s service offerings. His largest to-date is the construction of what is now an 18-program Clinical Care Path Suite. This suite of clinical solutions forms the foundation of MedOne’s benefit plans and corresponding savings strategies, enabling clients to save upwards of 25% on their pharmacy benefits while ensuring quality care and access to appropriate treatments. 

Additional notable accomplishments include: 1) Creating and formalizing a suite of specialty cost containment and access solutions under the sub-brand "RxAlly" designed to help MedOne members gain access to high-cost medications, 2) delivering actionable clinical insights and recommendations to optimize prescription benefit plans and reduce overall spend while ensuring positive clinical outcomes, and finally 3) driving innovation through the integration of cutting-edge technologies to improve data delivery through the use of Macros, bots, AI, and other technologies not often associated with PBM.

Within the Clinical Program Suite lies one of MedOne’s most impactful programs: Opioid Care Path. This is a risk stratification and mitigation program in which MedOne is able to identify members taking opiate products and evaluate risk across five different parameters. If patients deviate and start showing behaviors that can indicate abuse and addiction, MedOne is able to intervene more quickly to change the dynamic to steer members onto a better path. Amid the nationwide opioid epidemic, MedOne is proud to offer such an impactful program. 

In addition to his clinical contributions, Dr. Harold has been a driving force behind the creation and growth of MedOne Pharmacy Services, the company’s on-site mail order and specialty pharmacy. He holds 32 state licenses and has secured strategic partnerships to enable shipments to members in all 50 states. 

"In a rapidly evolving industry, Nate's curiosity and determination to find better solutions consistently elevate our offering. As Nate steps into his new role as Chief Pharmacy Officer, I am excited to see the innovative solutions he will bring to all those we serve. His vision and dedication will undoubtedly continue to propel MedOne forward,” said Hartig. 

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Dr. Harold was named a 2023 Rising Star by the Telegraph Herald. He earned his Doctorate of Pharmacy degree from the University of Iowa after completing his undergraduate studies in Chemistry at Iowa State University.

Beyond his professional achievements, Dr. Harold is deeply involved in community service. He currently serves on the Iowa Pharmacy Association Practice Transformation and Legislative Affairs advisory committees, he serves on the Sister Water Project Committee working to ensure clean water access for the people of Tanzania and Honduras, and is an avid supporter of animal welfare and fosters collies through the Collie Rescue of Greater Illinois and the Minnesota Wisconsin Collie Rescue. He is a past member of the Genesis Alumni Board at the University of Iowa College of Pharmacy and past member of the Greater Dubuque Development Corporation Future Leaders Committee.

As MedOne continues to expand its reach and impact, Dr. Harold’s leadership as Chief Pharmacy Officer will be a driving force behind the company’s strategic goals. These include advancing its clinical capabilities, strengthening client partnerships, and achieving measurable results across its core pillars of lowest net cost, health outcomes, and member satisfaction.

The 7 Core Values at MedOne | MedOne News | MedOne - Pharmacy Benefit Solutions
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The 7 Core Values at MedOne

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At MedOne, we take our Core Values very seriously. They shape everything we do from the tone in which we answer calls to the structure of our pricing model. 

Each year, we revisit the values to evaluate how we’re doing as a company as we grow and evolve. They are the foundation of MedOne’s company culture after all. So we evaluate: Are they an accurate representation of the culture we want to build here at MedOne? Are these the values our employees exemplify day in and day out? (We hope so!) Is there anything missing? Have we changed or developed in a way that would justify an edit to the MedOne Core Values? 

This year, we did just that. Our seventh Core Value underwent some workshopping. 2024 brought forth quite a bit of change in terms of product offerings and key capabilities. Therefore, we saw the need to refresh the final Core Value to reflect our innovative mindset. 

Introducing the 2025 MedOne Core Values: 

Prioritize your well-being

This core value is the first core value for a reason. Family and personal well-being is more important than any job or career, and we truly mean that. If your physical body comes to work but your mind is elsewhere, we have an issue. So take care of your mind, body, and soul in whatever way makes sense for you. 

What does this look like?

Take time for family events. Take appropriate breaks throughout your day. Use your PTO (Please! It’s there for a reason!). Ask for help if you start to get overwhelmed. Arrange for coverage and communicate when you need time away. Take care of you. 

Act as a MedOne team

We can't do it alone. Given the growth of our team over the last 3-5 years, we know this one to be especially true. We need to RAVE (Respect, Appreciate and Value Everyone), focusing on the fact that teamwork can look different from person to person or department to department. The unifying factor: We need each other to succeed. 

What does this look like?

Treat everyone with respect. Practice clear, concise, timely communication. Give credit for support, help, or ideas when it’s warranted. Consider the impact of plans and actions across departments (not just your own). Create common strategies that support each other. Get to know your team and let your team get to know you - be open.

Care for members with compassion

Members are at the heart of what we do; they’re why we come to work each day. Members are not numbers. They are people with needs and we are in the fortunate position to help them navigate the wild world of healthcare. We strive to simplify the complicated and do so with empathy and compassion.

What does this look like?

Listen to members with empathy. Go the extra mile. Use language that confirms you understand their situation. Help them like you would a loved one. Work with purpose to resolve their issues. Practice 360 degree communication - If we can't resolve the member's issues immediately, we'll reach out to the provider, pharmacy and circle back with the member on the resolution progress within 24 hours. Don't make it hard for our members.

Strive to exceed client expectations

Prove we are reliable and effective from the get-go. Each interaction should leave our clients educated, satisfied, and happy. We need to earn our role as a key, strategic, and trusted partner to our clients.

What does this look like?

Foster positive and mutually beneficial relationships. It is important to manage expectations in an effort to under-promise and over-deliver. Solve current and future problems - we should work to anticipate, predict and address our client's questions before they pose them. Overperform against minimum contractual guarantees. Educate clients to make sound business decisions. Provide detailed reporting and make proactive recommendations to solve customer problems. Communicate clearly, concisely and accurately. Listen to customer feedback. Be enthusiastic. Be unexpected.

Do the right things for the right reasons

This is at the core of our founding story. Our founder saw things in our industry that he didn’t believe were right. Honesty and integrity drive our decisions. We differentiate ourselves by always explaining the "why" behind our actions in an industry where it is difficult to get a straight answer. While we need to make money, profit is not our only motivator. Overall, the focus of this Core Value is to just be a good human. This is the #1 thing we hire for. We can teach the ins and outs of PBM, what a PA is, and how to run a report. But we can’t teach you how to be a good person; that’s on you. And we expect that from each and every one of our employees (as well as our vendors and partners). 

What does this look like?

Take the right path, not the easy one in our daily interactions with the team, clients, and members. Be transparent and upfront. The toughest conversations are where we see growth and trust start to build. Overall, just be a good human. 

Bring your best

We are professionals and we need to bring our A-game to work. Continued focus on process and procedure will help us reach our goals with relatively few pain points. Mistakes will happen. When they do, we will seek out the process failure rather than someone to blame with the goal of preventing the problem from recurring. We will hold each other accountable to the process or procedure. Showing up better today than yesterday.

What does this look like?

Show up on time. Come prepared to meetings. Plan ahead. Don't give bad / inaccurate information. If you need to confirm and follow-up, confirm the information and follow-through on the follow-up. Be true to your word. Be clear about who is responsible for what. Be personally accountable. Ask what (happened/where breakdown was) not who.

Create & embrace positive change

This seventh and final Core Value underwent some workshopping this year. Previously, we rounded out the list with “Challenge the status quo” which is a great value to live by and still something we expect of our employees. The edit taking effect in 2025 extrapolates on this idea and prioritizes what happens after the “challenge.” What are we doing about the identified need for change? It must be acted upon; we need to both create AND embrace change in a positive manner in order to move forward. 

After all, there are only two options: make progress or make excuses. During onboarding, we ask each employee to “poke holes” in our processes. Ask why we do things the way that we do. Don’t be shy! This innovative mindset is where we see true growth and advancement. Our employees can take pride in the fact that by creating and embracing positive change, they are actively contributing to improving the MedOne experience.

What does this look like?

Ask WHY. And then ask it again. And maybe a third time. Drill down to get to the bottom of faulty functions or processes. Don't conform, offer your perspective. Work to eliminate redundancies or unnecessary steps (ie: Work smarter, not harder). Be innovative and stretch yourself. Don't rest on your laurels. Do better than you did yesterday. Measure and celebrate improvements.

Most companies have a set of core values. They’re often displayed on website or hung in lobbies, but how often are they practiced? Or even discussed? We challenge you to talk about them. Evaluate them. Expect them. From every employee at your organization. 

A Makeover at MedOne | MedOne News | MedOne - Pharmacy Benefit Solutions
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A Makeover at MedOne

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Exciting things are happening over here...

MedOne is persistently evolving and creating new ways in which we can better serve our clients and members. We would like to bring your attention to the pharmacy ID card members on the benefit receive. 

The New MedOne ID Card

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What is changing?

MedOne created a new design for the MedOne member ID cards. The MedOne ID cards - pertaining to the Rx benefit only - look different than they have in the past. 

The processing information, that the pharmacy uses, has not changed. We simply redesigned the front to make the key information stand out, and the back to feature a scannable QR code that directs members to the myMedOne Member Portal. Overall, this redesign provides more information with a sleeker, more modern design.

Why is this change occurring?

We identified the need to better brand our ID cards and make it clearer to members that the card was specific to their pharmacy benefit. The new design also makes key information easier to find for those entering the information at the pharmacy.

What can members expect?

Current ID cards are valid and members can continue to use them. Should a new ID card be requested in the future, the member will receive a card with the new design. Starting September 1, 2024, all MedOne-issued ID cards will feature the new design and will come in the mail in a two-card punch-out-style mailing.  

Nothing is changing for members who receive a combined medical & Rx ID card; these changes pertain only to MedOne-issued ID cards pertaining to the Rx benefit only. 

Will this affect active ID cards?

No, any currently active and valid ID card members have will stay active and valid. Should they request a new one, members will receive the new design shown above.

Is there any action needed by the plan sponsor?

There is no action required at this time.

If you have any questions or concerns about this new ID card design, please reach out to your MedOne account team. 

Enhancing Member Experience: Ongoing myMedOne Updates | MedOne News | MedOne - Pharmacy Benefit Solutions
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Enhancing Member Experience: Ongoing myMedOne Updates

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Enhancing Member Experience: Ongoing myMedOne Updates

At MedOne, we strive to continuously evolve to ensure our members experience seamless access to their pharmacy benefit information. With this commitment in mind, we're  introducing a range of new features to the myMedOne Member Portal that our development team has been diligently working on. These features include an "Act As a Dependent" feature, additional information on the “My Rx Lookup” tool, and “My Rx Lookup Filtering, Sorting, & More Pricing Results.”

Act As a Dependent

The primary cardholder on a benefit can use a new drop-down option to access information on other dependents under age 18 that are covered on the benefit. This view allows them to “act as their dependent” on myMedOne. This functionality enables the member to utilize myMedOne as if they were logged in as their dependent. This includes:

  • Viewing the dependent's progress towards deductibles and out-of-pocket expenses in the "My Progress" card.
  • Accessing the dependent's fill history through "My Recent Rx Fills" and "My Rx Fill History."
  • Reviewing the dependent's prior authorizations via "My Prior Authorizations."
  • Pricing medications and accessing coverage information as the dependent via "My Rx Lookup."

How It Works

If the user has permission to access dependent information, they will notice a drop-down menu titled "Member" in the application header. From this drop-down, users can view who they are currently acting as and can switch to another member by selecting them from the menu. Upon selecting a different member, the cards and pages within the application will update to display the dependent's information.

If a user does not have access to a dependent, they will not show in the dropdown. Furthermore, if a user doesn't have any dependents, no dropdown will be displayed.

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Limitations and Restrictions

The feature comes with certain limitations, which include:

  • This feature is exclusively available for the primary cardholder (01). 
  • Access to a spouse's information is not permitted due to HIPAA restrictions, even if they are listed as a dependent. However, this capability is planned for future development and implementation into the myMedOne Member Portal. 
  • Only information for dependents under 18 years of age is accessible. Once a dependent reaches legal adulthood, their information becomes inaccessible.

My Rx Lookup | Pricing Disclaimer

In the My Rx Lookup feature, members are now required to agree to the pricing result disclaimer. There are many factors that affect drug prices. These fluctuate often and many are out of the control of MedOne. Therefore, it is important to note that while we strive to provide accurate pricing information, we cannot guarantee with 100% certainty the exact medication and price that a given pharmacy will fill. This update aims to inform members of any potential discrepancies. Additionally, we have enhanced the visibility of the pricing disclaimer on the pricing results page to ensure members are fully aware of this information.

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My Rx Lookup | Filtering, Sorting, & More Pricing Results

MedOne has introduced the option to filter and sort pricing results within the My Rx Lookup feature. Members now have the capability to narrow down pricing results to specific pharmacies. Additionally, members can sort the results by:

  • Distance (Near to far)
  • Member Pay (Low to High)
  • Member Pay (High to Low)
  • Plan Pay (Low to High)
  • Plan Pay (High to Low)
  • Pharmacy Name (A - Z)
  • Pharmacy Name (Z - A)

This helps member find the information that’s most important to them first and all around aids in the navigation through the My Rx Lookup tool. 

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Additionally, we've expanded the number of pricing results available for a single zip code, enabling members to view more options in their local area.

If you are an existing member of a MedOne pharmacy benefit plan, discover these new features on the myMedOne member portal at my.medone-rx.com. Register using the member ID number found on your insurance card to unlock these enhancements.

Unlocking Better Pharmacy Benefits | MedOne News | MedOne - Pharmacy Benefit Solutions
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Unlocking Better Pharmacy Benefits

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Empowering MedOne Members with New Features | MedOne News | MedOne - Pharmacy Benefit Solutions
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Empowering MedOne Members with New Features

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MedOne is proud to unveil the latest enhancements to the myMedOne Member Portal: "My Prior Authorizations" (PA) and "My Rx History." 

The addition of these two features are pivotal in our mission to equip all MedOne members with the tools they need to access and understand their pharmacy benefit.

“We are excited to provide members with an unmatched level of insight and transparency into the prior authorization process.

Dr. Nate Harold, VP of Clinical Services

Prior authorizations account for roughly 60% of inbound call volume to our Member Advocate team. Equipping members with the ability to check the status of their PAs eliminates the need to call in, giving them access to the information they need faster than has been historically possible. 

Dr. Nate goes on to say, “We understand that prior authorizations are a major cause of frustration for providers and patients alike. By giving members a greater level of insight and expectation management, we are bringing new levels of alignment to ensure members can obtain the most appropriate treatment at the best price.”

My Prior Authorization

Accessible via the myMedOne landing page or the slide-out navigation, the "My Prior Authorizations" screen aims to inform members about the status of their prior authorizations. This screen showcases both current and past PAs, presenting a range of statuses. Possible status messages include: 

  • Approved
  • Partially Approved
  • In Progress
  • Expiring
  • Expired
  • Denied
  • Aborted

Members are empowered with actionable insights corresponding to these statuses, allowing them to actively participate in their prescription journey.

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My Rx History | Sort, Filter, & Pagination

MedOne has also introduced pagination to the My Rx History page. Initially displaying 10 fills per page, sorted from newest to oldest, members can seamlessly navigate through pages to access their prescription claims history. 

Members now enjoy the flexibility to sort and filter their claims, particularly beneficial for those with extensive fill histories.

Sort options include:

  • Fill date
  • Medication name
  • Member pay
  • Plan pay

Filter options encompass Year, Medication, and Pharmacy.

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MedOne is committed to empowering our members. These myMedOne enhancements, as well as the many which are to come, help ensure that MedOne members have easy access to the information they need most. Additional updates and feature launches are slated to continue throughout 2024 and beyond. If you have any questions concerning your pharmacy benefit or myMedOne, please contact our Member Advocate team at 888-884-6331.

If you're a member of a MedOne pharmacy benefit plan, discover these new features on the myMedOne member portal at my.medone-rx.com. Register using the member ID number found on your insurance card to unlock these enhancements.

A Moment from MedOne: March 2024 | MedOne News | MedOne - Pharmacy Benefit Solutions
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A Moment from MedOne: March 2024

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On behalf of all of us at MedOne, we appreciate the opportunity to serve all our customers. We are especially appreciative in combination with our upcoming 25th anniversary in early April. Going back to our roots since being founded in 1999, we are passionate about being private and family-owned, and our 100% transparent, pass-through model that has existed since Day 1.

What's New in Pharmacy?

This newsletter provides a quick touchpoint on some news and happenings across the industry. It also allows us to say a friendly "hello" and connect to say thank you for being part of the MedOne family.

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Our thoughts on the Ozempic lawsuit.

Have you heard? Over 10,000 patients have filed adverse event reports against specific GLP-1s (article link below), claiming inadequate warnings of severe side effects. The most common? Gastroparesis – a chronic condition where the nerves and muscles in the stomach wall severely weaken. GLP-1s were not originally designed to be an anti-obesity drug. They are a Type 2 diabetes therapy.

In 2023 at MedOne, Ozempic prior authorization denials were more than double the number of denials for any other drug. The major reason for the denials was due to off-label use (anti-obesity).

As new weight loss drugs (Wegovy, Zepbound, etc) come to market, MedOne has developed strategies to help employers know when and where it makes sense to cover these drugs.

View full article on LinkedIn.

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Insulin price cap takes effect, lowering costs for many Americans.

View full article from USA Today.

Push for Stelara Biosimilar: The Next Humira

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Stelara has held the position of J&J's leading revenue-generating drug since 2019, but its crucial patents began to expire last year. In June, Alvotech and its Israeli partner, Teva Pharmaceutical, entered into a settlement and licensing agreement with J&J for the introduction of the biosimilar, AVT04, no later than February 21, 2025, contingent upon receiving U.S. FDA approval. The regulatory decision is anticipated by April 16. Although a significant Stelara patent expired in the United States last year, J&J secured agreements with competitors to postpone the launch of their biosimilars until 2025. Amgen is set to be the first to introduce its comparable product, Wezlana, in the coming year.

View full article from Fierce Pharma.

Coverage Change for Vyvanse (Lisdexamfetamine)

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ADHD Medication Shortage

We are heading into the second year of experiencing a nationwide shortage of ADHD medications such as Vyvanse, Adderall, and their generic alternatives. Regardless of the cause, MedOne is committed to ensure members have access to an appropriate prescription at an affordable cost.

Formulary Change

Some brands like Vyvanse are excluded from the Performance Formulary due to the availability of generic alternatives. The MedOne Formulary Subcommittee meets weekly to evaluate market changes and adjust formularies as necessary.

Recently, the Subcommittee discussed the shortage of ADHD medications. They evaluated the cost impact and the impact on clinical outcomes and member/client satisfaction and determined it was best to allow brand Vyvanse on formulary in a non-preferred tier until the generic becomes readily available.

Contact your MedOne Account Management team for additional details.

Read more information about the formulary change.

Regulation Watch

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Federal Trade Commission Chair Targets PBMs

Amidst an FTC investigation of PBM middlemen, Commission Chair Lina Khan relays the “Big 3” haven't filly cooperated. “So far, the PBMs have not fully complied with our orders to turn over documents and data,” she said. “FTC orders are not suggestions and we will not hesitate to use the full extent of our legal authorities to mandate compliance.”

View full article from Ohio Capital Journal.

Government Entities Launch Inquiry

The FTC, the Department of Justice's (DOJ) Antitrust Division, and the U.S. Department of Health and Human Services launched and RFI on “deals conducted by health systems, private, payers, private equity funds, and other alternative asset managers that involve heath care provider, facilities, or ancillart products or services.”

View full article from The FTC.

Consolidated Appropriations Act

Under the Consolidated Appropriations Act (CAA), self-funded group health plans are required to report data annually regarding prescription drugs and health care spending to the Departments of Health and Human Services, Labor, and Treasury (Tri-Agencies). The next due date for submission is June 1, 2024, and will encompass 2023 data. This data is submitted via a Centers for Medicare & Medicaid Services (CMS) web portal.

To support our clients’ self-funding group health plans, MedOne will submit the P2 and D3 – D8 files along with a narrative response for plans directly to CMS. (Please note, medical administrators may also be required to send some of these files, as per the CAA.) Our submission will include plans which had active coverage with MedOne during the reference year (2023).

If you have questions about the MedOne submission process, please reach out to Laurie Stowe, VP of Account Management, at lstowe@medone-rx.com.

Cyber Attack on Change Healthcare Carries Worldwide Impact

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What Happened:

As you may know, all pharmacies hire a switch vendor to route claims from their pharmacy management system to PBMs like MedOne. One significant switch vendor is Change Healthcare who is experiencing an outage (starting around 11:05 AM EST on 2/21/2024) preventing claims from reaching PBMs like MedOne. Various pharmacies and PBMs have confirmed this is an industry-wide issue and not isolated to MedOne. We're now learning, it's not isolated to pharmacy claims either. 

Service to MedOne members was impacted for a short time and while the Change Healthcare outage persists, MedOne found an alternative solution. 

Our Solution

MedOne was able to establish connectivity to receive claims from an alternative switch vendor named RelayHealth.

All pharmacies using RelayHealth will now be able to successfully submit claims to MedOne. While we believe many pharmacies have pivoted to RelayHealth, there still may be pharmacies unable to process claims. For those instances, we have some alternatives and workarounds in place. Please contact your MedOne Account Management team for additional details.

Read more about the outage from WIRED.

Save the Date!

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MedOne is celebrating 25 years in business here in April!

If you're local to the Dubuque area, please plan on joining us for an open house and ribbon cutting on Friday, April 12 from 7:30-10:00AM.

RSVP here.

Prescription Claims Processing Notice | MedOne News | MedOne - Pharmacy Benefit Solutions
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Prescription Claims Processing Notice

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As of 2/27/2024 3:14 PM CST, MedOne has successfully established connectivity with an alternative routing vendor and claims are processing.

MedOne is now processing claims through RelayHealth, and all pharmacies using RelayHealth will now be able to successfully submit claims to MedOne. For members who may have paid out of pocket over the past few days, we encourage them to work with their pharmacies to reverse and reprocess their prescriptions through insurance to avoid having to submit a Direct Member Reimbursement form to be reimbursed.

While we believe many pharmacies have pivoted to RelayHealth during the outage, there may still be pharmacies unable to process claims. For those instances, we reinforce our previous communication and resolution strategy noted in prior communications.

For any members needing assistance, please encourage them to contact our Member Advocate team at 866-335-9057.

What Happened: 

On Wednesday, 2/21/2024, Change Healthcare, part of UnitedHealth Group, suffered a cyber security attack from a suspected nation-state per its SEC filing. Among other services, Change Healthcare supports the routing of prescriptions from pharmacies to PBMs. In response to said attack, Change Healthcare disconnected its prescription routing service to limit impact. As of 2/28/2024 at 8:07AM EST, the outage persists. Change Healthcare expects the disruption to “last at least through the day.” 

Updates directly from Change Healthcare may be found here:

https://status.changehealthcare.com/incidents/hqpjz25fn3n7

For clarification, MedOne systems and data were NOT the target of the cyber security attack. Our systems were not affected or impacted. At this time, there is no indication that MedOne systems or data have been compromised. Claims that can be successfully routed from a pharmacy to MedOne will correctly process.

MedOne is committed to ensuring access to care for our members and apologize for any inconvenience our members may experience. For escalated member issues, MedOne has an Emergency Response Team to assist members in securing their emergency medications during this outage. 

We are actively monitoring the outage to keep abreast of adjudication status and downstream impact. Please contact your account manager or the MedOne Member Advocate Team at 866-335-9057 with any additional questions at this time.

Formulary Notice: Coverage Change for Vyvanse | MedOne News | MedOne - Pharmacy Benefit Solutions
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Formulary Notice: Coverage Change for Vyvanse

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ADHD Medication Shortage

We are heading into the second year of experiencing a nationwide shortage of ADHD medications such as Vyvanse, Adderall, and their generic alternatives. Regardless of the cause, MedOne is committed to ensure members have access to an appropriate prescription at an affordable cost.

Formulary Change

Some brands like Vyvanse are excluded from the Performance Formulary due to the availability of generic alternatives. The MedOne Formulary Subcommittee meets weekly to evaluate market changes and adjust formularies as necessary. Recently, the Subcommittee discussed the shortage of ADHD medications and decided to adjust the Performance Formulary Exclusions. They evaluated the cost impact and the impact on clinical outcomes and member/client satisfaction and determined it was best to allow brand Vyvanse on formulary in a non-preferred tier until the generic becomes readily available.

What This Means For You

When you go to the pharmacy to fill your preferred generic ADHD medication, your pharmacy may not have it. There are two options: 

Option 1
You can call MedOne and ask that they help source the prescribed generic at another nearby pharmacy or to see if other generics are available at your pharmacy.

Option 2
The pharmacy may dispense Vyvanse. However, please note that any brand medication that is dispensed is subject to any applicable brand copay. 

If you have NOT previously been prescribed Vyvanse or a similar brand, you may be subject to Step Therapy and Prior Authorization requirements. You may be required to step through two (2) preferred generic long acting stimulants before the plan would  allow a brand long-acting stimulant (Vyvanse or otherwise).

Please Note: DAW penalties will still apply. If you request a brand when a generic alternative is available, you will be required to pay both your brand copay PLUS the difference between the prescribed generic and the requested brand.

Please contact your MedOne Account Management Team for additional details.

Meet the New myMedOne Member Portal | MedOne News | MedOne - Pharmacy Benefit Solutions
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Meet the New myMedOne Member Portal

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DUBUQUE, January 12, 2024 — MedOne Pharmacy Benefit Solutions is proud to announce a new digital member experience called myMedOne that will change the way MedOne members look at their pharmacy benefits. 

"Our goal with myMedOne is to help our members more easily understand and access their pharmacy benefit."

Wes Hartig, CEO of MedOne

myMedOne, accessible at my.medone-rx.com, is available to individuals enrolled in a MedOne pharmacy benefit plan through their employer. All features of the myMedOne member application are designed to generate an efficient and streamlined member experience. Key features include an active tracker that records a member’s progress toward individual and family deductibles and out-of-pocket maximums; a comprehensive history of all prescription fills to date; easy access to pertinent plan information such as ID card processing information, pharmacy networks, and copay structures; ability to enroll in mail order; options to schedule a one-on-one consultation with an on-staff clinical pharmacist and more. 

Under the leadership of VP of IT Kyle Fisher, MedOne looked to Application Architect Andrew Ward, along with senior developer Nathan Luebbert and developers Irmak Erdem, Hector Morales, and Wilbert White to exclusively in-source the build of the portal. 

"Building myMedOne in-house allows us to leverage cutting-edge technology in order to empower and equip our members with a beautiful, easy-to-use portal that is curated to our members' specific benefits and needs," says Fisher. 

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Much of the feature focus surrounded the My Rx Lookup feature. This interactive tool allows members to search for a medication and see how it is covered on the specific member’s benefit as well as compare prices for the medication in a geographic area allowing the member to identify the most cost-effective pharmacies in their area. 

"MedOne is aligned with our clients’ success and our clients are aligned with their members’ success. When the member makes the right decision, we all win. This is how pharmacy benefits should work. We are focused on helping MedOne members get to the right medication at the best price as efficiently as possible. The launch of myMedOne is a significant step in furthering this goal," says Hartig. 

If you are a member of a MedOne pharmacy benefit plan, explore the new myMedOne member portal by visiting my.medone-rx.com and register using the member ID number found on your insurance card.

MedOne Partners with Mark Cuban Cost Plus Drug Company | MedOne News | MedOne - Pharmacy Benefit Solutions
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MedOne Partners with Mark Cuban Cost Plus Drug Company

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DUBUQUE, IOWA, August 18, 2023 — MedOne Pharmacy Benefit Solutions, a performance-based PBM serving employers nationwide, has integrated with Mark Cuban Cost Plus Drug Company, PBC (Cost Plus Drugs) to provide its members with easy access to more cost-effective medications.  

Effective August 18, MedOne members will have access to pricing and rates per Cost Plus Drugs' pharmacy and, when utilized, all patient spend will track to the patient's deductible and out-of-pocket maximum.  

Committed to providing a better benefit experience, MedOne's pass-through approach to PBM aligns with Cost Plus Drugs’ completely transparent philosophy. Just as MedOne passes all upside through to its clients, Cost Plus Drugs cuts out the middleman and negotiates directly with manufacturers to obtain the best possible prices, passing along those savings to the end patient. This results in easy access to safe, affordable medications for anyone who needs them in an industry historically layered with extra costs and price inflation.  

“As a practicing physician I saw first-hand the danger of patients not taking their medications because they couldn't afford them,” said Alex Oshmyansky, CEO of Mark Cuban Cost Plus Drug Company. “I founded the Mark Cuban Cost Plus Drug Company to help solve this problem and provide a way for patients to receive their medication at an affordable price." 

Notably, MedOne members can now access YUSIMRY™, a biosimilar of HUMIRA®, through Cost Plus Drugs for more than 90% less than the list price of HUMIRA®. MedOne covers YUSIMRY™ as a preferred medication and it is available to MedOne clients and members for $569.25 plus dispensing and shipping fees. 

"We support a future where pharmacies and manufacturers are able to set their own prices, which are extended to plans and patients without adjustment. We can’t accomplish this alone and we are excited to collaborate with Cost Plus Drugs.

Wes Hartig, CEO of MedOne.   

"We view it as our job to embrace innovators like Cost Plus Drugs and empower plans and patients to make the best choices,” said Wes Hartig, CEO of MedOne.    

Transparent and pass-through since 1999, MedOne's performance-based approach to PBM includes guaranteed results for its plan sponsor clients. MedOne goes at-risk to ensure all financial guarantees are met. Layering in the relationship with Cost Plus Drugs provides additional savings for both the plan sponsor and member. 

 "We already offer transparent, low prices to cash-pay consumers and are excited to now be working with PBMs like MedOne to further reduce the cost to patients, and to keep the patient record complete from both a clinical and financial perspective," said Oshmyansky.

To learn more about the MedOne model, please contact sales@medone-rx.com.

New Integration Streamlines MedOne Prior Authorization Processes | MedOne News | MedOne - Pharmacy Benefit Solutions
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New Integration Streamlines MedOne Prior Authorization Processes

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DUBUQUE, March 21, 2023 — MedOne Pharmacy Benefit Solutions, a Dubuque, Iowa-based PBM (pharmacy benefit manager) announces a new collaboration with CoverMyMeds that will allow members enrolled in a MedOne benefit plan to experience a streamlined prior authorization process via direct integration with CoverMyMeds' network of prescribers, EHR (electronic health records) systems, pharmacies, and pharmacy system vendors. This benefits both members and prescribers - helping reduce the amount of time between when a medication is prescribed and when it reaches the hands of the member. 

MedOne offers custom-built pharmacy benefit plans that employ a series of cost containment strategies in addition to operating on a pass-through model. These strategies, while cost-conscious in nature, ensure the appropriateness of medications prescribed to members enrolled in a MedOne plan. One of the most common strategies involved is the use of a prior authorization. This is a review conducted by an on-staff clinical pharmacist and ensures the safest and most cost-effective option within a therapeutic class is used as the first line of treatment. Prior authorizations are typically conducted on high-cost medications.

“Prior authorization continues to be an effective tool in helping ensure the treatments funded by our clients are safe, effective, and prescribed appropriately. The clinical information received and reviewed is critical in ensuring our members are treated with high performing treatments and setup to achieve positive health outcomes,” said Dr. Nate Harold, VP of Clinical Services at MedOne.

The process for conducting prior authorizations has evolved but often requires paperwork to be faxed to/from the prescriber's office and MedOne. The integration with CoverMyMeds leverages the use of ePA (electronic prior authorization), which helps eliminate the need for additional or dual paperwork to be submitted. This, in turn, minimizes the delay in claims processing, helping members to access their medications more quickly without sacrificing the process for determining a prescription’s therapeutic appropriateness.

“It is clear that prior authorization and the process of obtaining and reviewing clinical information has become an increasing burden on our healthcare system and specifically our providers.  As technology has advanced, we are in an ideal position to address these challenges to streamline the process, improve the time patients wait for a decision, improve information accuracy, and elevate the labor-intensive process of prescribers submitting clinical information. CoverMyMeds’ ePA solution provides a fast and easy way to complete prior authorization requests for our clients, pharmacies, prescribers, and most importantly, our members,” said Dr. Harold.