Seeing the future of self-insurance

As specialty drug spending accelerates and reimbursement pressures mount, hospitals and outpatient systems are increasingly rethinking how they manage financial visibility across the medical benefit. The latest 2025 PBM Customer Satisfaction Report from Pharmaceutical Strategies Group (PSG) offers important context for this shift.

Across the healthcare landscape, hospitals, infusion centers, and outpatient facilities are facing mounting financial pressure. In 2025, CMS reimbursement adjustments, biosimilar pricing shifts, and increased payer scrutiny have made maintaining predictable revenue more challenging than ever.

Self-funded employers have long recognized the importance of rebates in managing healthcare costs. Pharmacy benefit rebates are typically part of financial planning, built into projections, and often used to offset premiums or reinvest in employee programs.

As hospitals and health systems evolve into risk-bearing organizations, many are launching their own health plans or taking on delegated risk through Medicare Advantage, ACOs, and MSOs. This shift creates new opportunities for financial sustainability, but also introduces new challenges.