LifestyleFamily & ParentingEntertainmentTravelPetsAutomotiveRelationshipsScienceHealthPersonal FinanceBetter WorkplacesReaders Choice RankingsHealthFinanceProductsEducationWorkplacesCorporate ResponsibilityAll Rankings SocialFacebookInstagramThreadsYouTubeRedditTikTokTwitter/X Recent weeks have brought something rare to Washington: meaningful, bipartisan progress on health care costs—progress built on a simple idea that should extend across the entire system. Congress included significant pharmacy benefit manager (PBM) reforms in the 2026 spending package that strengthened transparency and rebate pass-through requirements—policies that shift financial incentives from industry middleman toward patient care. The Trump Department of Justice quickly reinforced this direction, with the Trump administration securing a high-profile settlement with Express Scripts that target…

That’s real progress. But it addresses only part of the cost equation. In the commercial market, drug spending is substantial. Yet hospital and facility services account for the largest share of medical expenditures—and therefore represent the greatest financial exposure for self-insured employers. Understanding why requires a closer look at how these employer plans work.