Image of a man and woman split screen left side image of woman and man losing hair. The right side of the image show regrowth of hair on both woman and man

The Next GLP-1? Why Hair Loss Drugs Could Be the Pharmacy Trend No One Saw Coming

by with No Comment Rx Insights

Just as plan sponsors begin to gain their footing on GLP-1 management strategies, another emerging category is quietly advancing through the pipeline: hair loss treatment.

Historically, treatment options for pattern hair loss have limited choices at a modest cost ranging from topical minoxidil (Rogaine®), to oral finasteride, and various off-label therapies. However, a new generation of non-specialty (VDPHL01) and specialty (PP405) medications are being developed that could significantly improve outcomes for both men and women experiencing hair loss.

Why Should This Concern Plan Sponsors?

Pattern hair loss affects approximately 80 million adults in the United States1, creating substantial utilization potential if these therapies receive FDA approval and gain market acceptance.

None of the medications discussed below are FDA-approved at this time, but they represent two pipeline products that could have meaningful clinical and financial implications for employer-sponsored health plans.

1. VDPHL01: Minoxidil 2.0

      VDPHL01 is an oral, non-hormonal hair loss pill used to treat men and women.  The extended-release oral minoxidil tablet delivers hair regrowth benefits while avoiding the heart-related risks tied to immediate-release oral minoxidil. Phase 2/3 Study results released April 27, 2026 show strong efficacy signals, with robust hair growth seen in both once-daily and twice-daily dosing. Phase 3 studies are still being conducted.

      If approved, VDPHL01 will become the first FDA-approved oral pill in nearly 30 years for treatment of pattern hair loss.2

      VDPHL01 Estimated Market Availability: Late 2027 to early 2028. (pending successful completion of clinical trials and regulatory review).

      Potential Financial Impact: Moderate to High

      Plan sponsors should pay close attention because:

      • Oral medications are easy to prescribe and administer.
      • Clinical studies suggest meaningful hair regrowth benefits.
      • The eligible population includes both men and women.
      • Even a modest annual treatment cost can generate significant plan spend when multiplied across a large member population.

        2. PP405: A Potentially Disruptive Stem Cell-Based Approach

        PP405 represents a very different approach to treating hair loss. Rather than targeting hormones or improving blood flow, PP405 is designed to reactivate dormant hair follicle stem cells and stimulate new growth at the cellular level. The therapy is being developed for both men and women with pattern hair loss.

        In a Phase 2 study, PP405 demonstrated a favorable safety profile with no treatment-related systemic adverse events reported. Phase 3 trials are expected to begin, although the product remains several years away from potential commercialization.3

        Consumer excitement around PP405 has been substantial because it represents one of the first therapies seeking to regenerate hair growth by reactivating dormant follicles rather than slowing the progression of hair loss.

        PP405 Estimated Market Availability: To be determined. The product remains in clinical development.

        Potential Financial Impact: Moderate to High

        From a pharmacy benefit perspective, this may be the more disruptive product.

        If larger clinical trials confirm strong efficacy:

        • Demand could be significant.
        • Use could extend across a broad population of men and women.
        • Treatment may begin earlier in the disease progression process.
        • Specialty-drug pricing could place additional pressure on pharmacy budgets.
        • Physicians may view treatment as preventative rather than purely restorative.

        How to Begin Assessing Your Rx Benefits Risk for Hair Loss Coverage

        12-24 months before launch:

        1. Assess whether your current Rx and/or Medical benefits provide for hair loss treatments.
        2. For Benecard plan sponsors, have your brokers contact Benecard for the number of eligible members and their utilization based on any hair loss treatment usage from the most recent 12 months.
        3. Rethink Plan Design and Utilization Management Options for Hair Loss Category:
          1. Exclude
          2. Prior Authorization
          3. Step Therapy
          4. Member Cost Sharing

        Although VDPHL01 and PP405 remain investigational therapies, both highlight a broader shift toward innovative treatments for highly prevalent lifestyle and quality-of-life conditions. For plan sponsors, the challenge will be balancing member access with responsible drug management tools in place prior to these drugs entering the marketplace.

        Getting ahead of these therapies now allows organizations to thoughtfully design coverage and drug management strategies before high demand and additional cost increases arrive. To talk pharmacy benefit strategy, contact your Benecard Representative at talktous@benecard.com.

        1. https://medlineplus.gov/genetics/condition/androgenetic-alopecia/#frequency
        2. Veradermics’ Oral VDPHL01 Achieved Early, Consistent, and Robust Hair Growth in Positive Phase 2/3 ‘302’ Clinical Trial in Male Pattern Hair Loss | Mon, 04/27/2026 – 07:00
        3. https://www.dermatologytimes.com/view/reactivating-the-follicle-pp405-moves-toward-late-stage-trials-for-alopecia
        FullSizeRender-8-scaled

        NJ SHBP & SEHBP 2027 Rate Recommendations Released – What You Should Know

        by with No Comment Rx Insights

        Last week, AON presented its recommended 2027 premium increases to the State Health Benefits Commission (SHBC) and the School Employees’ Health Benefits Commission (SEHBC) — and the numbers are substantial for both medical and Rx premiums:

        Note: Active and Early Retiree premium rate changes shown above apply to both the legacy plan options and new plan options that were effective as of July 1, 2026.

        Both the SHBP and SEHBP rate-setting analyses raise concerns that the proposed 2027 premium increases may not fully resolve the programs’ underlying financial challenges. In both cases, a portion of the increases is being used to repay prior funding obligations and rebuild depleted reserves, rather than solely cover projected healthcare costs.

        Key Concerns

        • Premiums exceed projected costs:
          • SHBP: Recommended premiums are set 11.3% above projected costs for Actives and 34.5% above projected costs for Early and Medicare Retirees, including repayment of the remaining $90 million Chapter 86 obligation.
          • SEHBP: Recommended Active premiums are set 15.9% above projected claims costs, including a 4.2% margin to repay the projected $70 million Chapter 28 obligation plus an additional 11.7% to help build the Claims Stabilization Reserve (CSR).
        • Reserves remain below target:
          • Despite these significant increases, both programs project CSR balances of only 1 month of plan costs, well below the recommended 2-month target.
        • Future increases may be needed:
          • Actuaries for both programs caution that additional margin may be required, signaling the potential for further premium increases in 2027 and beyond.
        • Participation risk:
          • The analyses warn that rising costs will likely drive lower-risk employers out of the plans, increasing costs for those who remain and potentially creating additional financial pressure.
            • SHBP: This includes anti-selection assumptions of 5% in 2026, and 3% in 2027 reflecting the increased risk of employers choosing to leave the plan as a result of the additional cost.  This level of anti-selection may be insufficient if attrition from the plan is significant.
            • SEHBP: This includes anti-selection assumptions of 5% in 2026, and 4.75% in 2027 reflecting the increased risk of employers choosing to leave the plan.  Active enrollment is expected to decrease to 8.75% in 2027.

        Bottom Line

        While these increases are still recommendations and are not yet finalized, they reflect the ongoing financial instability in the state plans. Employers, employees, and retirees risk needing to absorb substantial premium increases, reduced benefits, and more out-of-pocket cost sharing with little confidence that it will be enough to meet targets and avoid future rate hikes—raising concerns about long-term affordability and sustainability.

        Benecard will continue to update you on any further developments with the final 2027 rate actions as more information is released.

        In the meantime, for plan sponsors enrolled in the SHBP or SEHBP, now is the time to start evaluating alternative options. In this volatile market, Benecard’s fixed-rate prescription benefit model can offer greater predictability and stability. Contact Richard Van Noord, Vice President of Sales, at Richard.VanNoord@benecard.com or (609) 651-5412 to learn about our unique prescription benefit solutions and to start a quote.

        Sources:

        1. Plan Year 2027 Rate Renewal Reports (recommendations):                                
        https://www.nj.gov/treasury/pensions/rate-renewal.shtml

        2. Aon’s SHBP “Plan Year 2027 Rate Setting Recommendation Analysis” Local Government draft report: https://www.nj.gov/treasury/pensions/documents/hb/rate-renewal/py2027-rate-setting-analysis-local.pdf

        3. Aon’s “2027 SHBP Rate Setting Analysis” draft report presentation: https://www.nj.gov/treasury/pensions/documents/hb/rate-renewal/shbp-2027-rate-setting-analysis.pdf

        4. View Aon’s SEHBP “Plan Year 2027 Rate Setting Recommendation Analysis” Education draft report: https://www.nj.gov/treasury/pensions/documents/hb/rate-renewal/py2027-rate-setting-analysis-education.pdf

        5. Aon’s “2027 SEHBP Rate Setting Analysis” draft report presentation: https://www.nj.gov/treasury/pensions/documents/hb/rate-renewal/sehbp-2027-rate-setting-analysis.pdf

        A roll of one hundred dollar bills sits among a row of prescription medication bottles. Photographed with a very shallow depth of field with the focus on the roll of money.

        The Key to Predictable Pharmacy Costs for School Districts

        by with No Comment Rx Insights

        Rising healthcare costs are forcing employers to make increasingly difficult financial decisions. Nowhere is this more evident than in public school systems. A recent BenefitsPRO article highlighted findings from a national survey of public school districts, where nearly every district reported significant budget pressures from escalating healthcare costs. Many now devote as much as 30% of their operating budgets to employee benefits, with prescription drugs—including specialty medications and GLP-1 therapies—identified as major cost drivers.

        For benefit consultants and plan sponsors, the message is clear: controlling pharmacy benefit costs has become a necessary focus to improve overall healthcare affordability without sacrificing member care, particularly for organizations like school districts that must balance fiscal responsibility with contractual obligations and mission-driven outcomes.

        An Independent PBM with a Proven Track Record of Cost Stability

        Unlike many PBMs that are owned by pharmacy chains or health insurers, Benecard remains one of the few independent, standalone PBMs in the marketplace. For nearly 40 years, our singular focus has been helping employers and school districts achieve clinically sound, financially responsible prescription benefit solutions.

        More importantly, Benecard stands apart with its 100% risk-free, guaranteed-cost prescription benefit arrangement. Benecard’s fixed monthly program charges—determined on a per employee per month (PEPM) basis—bundle prescription drug claims, rebates, administrative fees, clinical management programs, and excess loss insurance protection into one predictable monthly cost. This proven model eliminates all financial risk to the plan sponsor and offsets claim costs immediately with upfront rebates being accounted for beginning in the first month, while providing the budget certainty organizations—especially school districts—need in today’s volatile healthcare environment.

        For districts navigating multi-year labor agreements and taxpayer-funded budgets, this level of predictability supports smarter financial planning without requiring ongoing renegotiation of employee benefits.  See our proven results by clicking here for our case study. To see what benefit consultants think of our services click here.

        Proven Purchasing Power That Delivers Long-Term Results

        Benecard also administers multiple Group Purchasing Arrangements (GPAs) that have been successfully operating for more than a decade. These established purchasing arrangements leverage collective buying power while maintaining flexibility for participating employer groups, including public sector entities like school districts. The results speak for themselves:

        • Stable rate action histories
        • Annual prescription drug trends consistently outperforming broader market averages
        • Sustainable savings—not just short-term savings strategies

        For school districts, joining a GPA is particularly valuable. One of the key advantages of joining any GPA we administer is that there are no mandated benefit design changes—plan sponsors retain 100% autonomy over their benefits.

        Therefore, rather than reacting to rising pharmacy costs with concessions at the bargaining table or cuts to student-facing investments, districts can adopt a structure that supports financial discipline and labor stability.

        A Better Path Forward

        As healthcare costs continue to rise, employers don’t have to accept unpredictable prescription benefit expenses as the new normal. With an independent PBM, guaranteed-costs, and proven savings strategies, Benecard helps organizations replace uncertainty with stability—protecting both employer budgets and employees’ access to quality pharmacy care.

        For school districts in particular, this approach offers a path to regain control over one of the fastest-growing cost concerns, while respecting collectively bargained agreements and ensuring that more resources remain focused where they matter most: supporting educators and improving student outcomes.

        If you’re looking for a better way to manage rising prescription benefit costs while bringing greater budget certainty, we’d welcome the opportunity to show you how Benecard’s proven approach can help. Please reach out to us at talktous@benecard.com to start the conversation.

        Sources:

        1: BenefitsPRO, “Rising health care costs force schools to cut benefits and tap reserves,” June 23, 2026, summarizing findings from the AASA and ASBO International report Rising Premiums, Falling Opportunities: The Budgetary Impact of Health Care Costs on School Districts.

        Balance scale with green cash on left side and orange prescription bottle on right side

        Get the Whole Picture on Level Funding: Look at The Advantages and Limitations

        by Rx Insights

        As plan sponsors and benefit consultants consider ways to reduce costs and gain flexibility for their health care benefits, the concept of level funding the prescription benefit is getting more attention. There are some advantages to level funding, as well as limitations, but a deeper dive also shows other funding arrangements may be better.

        Level Funding Advantages

        Level funding is a hybrid funding model that mixes elements of self-funding and may also include stop-loss protection. It features a fixed monthly cost billed to the plan sponsor, with total costs reconciled against actual claims at the end of the contract year. This funding arrangement can offer advantages over fully insured plans, such as the potential for refunds based on positive performance (at the PBM’s discretion) and benefit design flexibility. Conversely, this funding arrangement may offer some level of risk protection as an advantage over self-funding.

        Level Funding Limitations

        Level funding may include stop-loss insurance—either individual incident stop loss (per claim or per covered life), aggregate stop loss, or both—which help share the risk with the plan sponsor. This arrangement comes with several considerations that warrant careful evaluation:

        • If claims exceed the carrier’s stop loss liability at any point during the contract year, the plan sponsor will be 100% responsible for these additional costs, which would be beyond the fixed monthly costs they paid in that given contract year.
        • In some instances, the stop-loss carrier could impose limitations, such as adding an individualized high-cost deductible to the specific individual at risk or not covering the high-cost drug and leaving the plan sponsor with the financial risk to pay for it, referred to as lasering. 
        • If an adverse market event occurs, the PBM can increase the level-funded rates at any time in that given contract year or terminate the agreement with 30 days’ notice.
        • Reconciliation occurs six months after the end of the contract year to settle any differences in payments.

        A Level Funding Alternative That Covers 100% of the Risk & Has A Proven Track Record

        When it comes to guaranteeing the Rx benefit and taking on 100% of the risk, Benecard’s guaranteed cost, fixed rate program takes any potential concerns off the table by providing absolute budget predictability and returning 100% savings back to the plan sponsor. With a reliable and proven track record of working with public sector entities for nearly 40 years, our program offers:

        1. A fully guaranteed funding model, with no reconciliation or risk beyond the fixed monthly program charges (regardless of how high claims may rise), all underwritten specifically to the plan sponsor’s defined pharmacy benefit plan.
        2. No additional invoices for administration fees or clinical program fees, such as those for prior authorizations.
        3. 100% return of savings delivered back to the plan sponsor based on positive plan performance.
        4. Plan sponsors retain full autonomy of their benefits, without any lasering.
        5. Comprehensive clinical programs included as part of the standard program offering, at no additional charge.

        With high trends in the industry along with more cost uncertainty, an offering that provides peace of mind without administration headaches, 100% return of savings for positive plan performance, monthly fixed program charges for budget predictability, and full plan sponsor control, is a strong alternative to the typical level funded or self-funded with back end stop loss models. Of course, we offer other funding arrangements to meet your needs.

        If you would like to discuss more about how Benecard can help assist with 100% risk protection, budget predictability, plan design flexibility, and a return of savings offering, please reach out to us at talktous@benecard.com.

        Sources:

        https://npabenefits.com/disadvantages-of-level-funding

        https://ethosbenefits.com/level-funded-health-insurance-pros-and-cons

        https://www.hcaa.org/page/selffundingstoploss#:~:text=Stop%2Dloss%20insurance%20(also%20known,and%20aggregate%20stop%2Dloss%20coverage

        Part 2 of a 2 Part Series Spotlight. Image includes a briefcase and healthcare symbol with prescription drug bottle and 2 red and yellow capsules against a blue background.

        3 Questions to Ask When Evaluating a Bundled Medical and Prescription Benefit

        by Rx Insights

        When evaluating the alleged advantages of a bundled medical and pharmacy approach, employers and consultants should ask their medical carrier a few critical questions:

        1. Does the carrier outsource its prescription drug program to a Pharmacy Benefit Manager (PBM)?
        2. Is there documented cost savings from bundling medical and prescription benefits—and where is the reporting that validates those savings?
        3. Will the carrier share medical claims data with a carved‑out PBM to support clinical programs and cost‑containment efforts?

        Most medical carriers already use external PBMs to administer their bundled prescription drug programs—evidence that specialized expertise is crucial in this field. For example, Horizon partners with Prime Therapeutics, Cigna with Express Scripts, UnitedHealth Group with OptumRx, and Aetna with CVS Caremark to manage prescription drug benefits for their employer-sponsored plans.

        These relationships clearly demonstrate that medical carriers and PBMs do not operate on fully integrated adjudication or reporting systems. Yet they successfully and routinely exchange detailed medical and pharmacy claims and payment files. This proves that medical carriers can—and already do—work effectively with external PBM partners.

        Importantly, medical carriers are not limited to sharing data with their affiliated PBMs. Most will also share medical data files with an employer’s selected carve‑out PBM, allowing care coordination, clinical programs, and cost‑management strategies to be implemented effectively.

        These factors prompt additional important questions that remain unanswered:

        • If a carve‑out PBM can receive the same comprehensive data as an affiliated PBM, why wouldn’t the medical carrier still be able to deliver the same—or better—cost savings?
        • If coordination and data sharing can exist outside of a bundled arrangement, why do some medical carriers impose monetary penalties when an employer chooses to unbundle the prescription drug benefit?

        Bring these questions to the table at your next meeting with your bundled medical carrier.

        If you would like to discuss more about how Benecard can help assist in validating savings to your medical program through our Pharmacogenetics program and working with your medical carrier to cross share data files, please reach out to us at talktous@benecard.com.

        If you missed part 1 of this spotlight, click here to read.

        Sources:

        1. https://www.ftc.gov/system/files/ftc_gov/pdf/pharmacy-benefit-managers-staff-report.pdf#page=16

        Image of Briefcase and health plan symbol with a prescription drug bottle and pills. Part 1 of a 2 part series spotlight

        Bundled Medical and Rx Benefits: Smart Strategy or Costly Trade-Off?

        by Rx Insights

        It is still commonplace for employers to have their medical and prescription drug benefits bundled together (carved-in).  However, new federal Prescription Benefit Manager (PBM) reforms such as the Consolidated Appropriations Act (CAA) 20261 focus on transparency and fiduciary responsibilities, highlighting the importance of understanding where and how your money is being spent.  

        Do Bundled Benefits Actually Deliver Savings?

        Some medical carriers, under a fully insured funding arrangement, impose monetary penalties on employer-sponsored plans who choose to unbundle (carve-out) their prescription drug benefits.  These carriers often claim that bundling medical and pharmacy services generates cost savings by enabling integrated data analysis, but where is the proof? In many cases, employers are not provided with clear or verifiable reports that validate such savings. 

        Consider this… most medical carriers rely on external PBMs to administer their bundled prescription drug benefits—an acknowledgment that specialized expertise is essential in this area.  This clearly supports the idea that medical carriers and PBMs do not operate on fully integrated adjudication or reporting systems, weakening the argument for bundled benefits. Additionally, most PBMs are fully capable of sharing detailed, timely claims data with medical carriers, which does achieve the same level of coordination as a bundled model. This raises a fundamental question: if comparable outcomes are achievable without bundling, why are monetary penalties necessary? A valid question to bring to your bundled medical carrier to answer.

        What Happens to Benefit Integrity?

        Bundling often creates commingled data that lacks accuracy and transparency. For example, medical devices such as insulin pump supplies are intentionally adjudicated or paid under an employer’s prescription benefit rather than the medical benefit. Such inconsistencies can create challenges for the employers, especially during request for proposal (RFP) evaluations, budget forecasting, and the transition process during a carrier change.

        What if Medical Cost Savings Could Be Validated Through the Prescription Benefit?

        Medication failure is the largest avoidable cost in any health plan—yet it’s often overlooked. Overall, it’s costing $3.5 billion in emergency room visits due to wrongly prescribed medications.2 Compounded by the fact that 50% of medications prescribed are either ineffective or minimally effective.3

        The biggest opportunity to reduce spend isn’t where most plans are looking and it doesn’t require collective bargaining or benefit changes.  Medication failure often leads to unnecessary emergency room (ER) visits and inpatient stays. Integrating medical and prescription data with a pharmacogenetics program can result in savings to the employer’s medical plan and better member adherence to their prescription drug regimen.

        Benecard addresses medication failure head on through personalized medication therapy for members in an employer’s group. This is achieved with the help of clinical pharmacists, PGx testing (type of DNA testing), and data science. The savings are often seen on the medical side through lower emergency room visits and inpatient stays. 

        Next time you look at a bundled medical and prescription drug quote, consider these factors before deciding to bundle or unbundle your benefit.

        To read part 2 of this spotlight, click here. If you have questions you would like to discuss with us, please contact us at talktous@benecard.com.

        Sources:

        1. https://www.congress.gov/bill/119th-congress/house-bill/7148

        2. Watanambe, McInnis. Annals of Pharmacotherapy 2018, Vol. 52(9) 829-837

        3. FDA. Paving the Way for Personalized Medicine. 10/2013

        NJ State Flag with US Flag behind it flowing in the wind. NJ Flag is yellow, blue and red.

        NJ SHBP-LG Mid-Year Report Confirms Continued Financial Plights

        by Rx Insights

        On March 30th, the New Jersey Department of Treasury released Aon’s Midyear Experience Analysis Report for the State Health Benefit Program Local Government (SHBP-LG).  The report reveals that the SHBP-LG continues its troubling financial position despite significant rate increases implemented on January 1, 2026. It also indicates that, following those increases, the claim stabilization reserve (CSR) was expected to improve to $340 million. However, the updated analysis suggests the SHBP-LG CSR is expecting a deficit of more than $200 million by the end of this year.

        The report documents various factors for the SHBP-LG’s continued financial deterioration including but not limited to:

        1. Trends continue to run high with the most recent 12-month period reflecting 10.7% and 21.7% increases in medical and prescription, respectively for the Actives population.
        2. Enrollment decline in the SHBP, as groups continue to leave the state and enter into direct contracts with private carriers in favor of more affordable coverage.

        The main cost drivers for the SHBP-LG Actives prescription plan comes from GLP-1 and anti-inflammatory drugs. GLP-1 drugs account for four of the top five drugs in terms of drug spend, while anti-inflammatory drugs make up three of the top 11 drugs based on drug spend.

        Although the report does not implicitly forecast exact rate actions for January 1, 2027, it does imply by the negative CSR forecast, continued double digits of trends, and loss of membership a possible need for another significant high increase and/or major changes to existing plan designs.

        Benecard remains actively engaged in monitoring this situation and will continue to keep you informed of any updates related to the NJ SHBP-LG. If you have questions or would like to discuss, please reach out to us at talktous@benecard.com.

        Sources:

        https://www.nj.gov/treasury/pensions/documents/hb/rate-renewal/mid-year-analysis-local-gov-PY2025.pdf/mid-year-analysis-local-gov-PY2025.pdf

        https://www.nj.gov/treasury/pensions/documents/hb/rate-renewal/SHBC-mid-year-analysis-presentation-PY2025.pdf

        Teacher in classroom with student raising hand.

        NJ SEHBP Mid-Year Report Confirms Continued Financial Troubles

        by Rx Insights

        This past week, the New Jersey Department of Treasury released Aon’s mid-year financial report for the School Employees Health Benefit Program (SEHBP).  The report shows the SEHBP continues its troubling financial situation despite implementing large rate increases which took place January 1, 2026. It also suggests that after the large increase for 2026, the claim stabilization reserve (CSR) funding was expected to have improved to $121 million. However, the updated analysis suggests the SEHBP will now be at a $30 million negative CSR by the end of this year.

        The report documents three significant factors for the SEHBP’s continued financial deterioration:

        1. Trends continue to run higher than expected with the most recent 12-month period reflecting 12% and 24% increases in medical and prescription, respectively.
        2. Enrollment decline in the SEHBP, as groups continue to leave the state and enter into direct contracts with private carriers in favor of more affordable coverage.
        3. Continued mandated migration of new members into the Educator’s Health Plan (Chapter 44) at undervalued rates that don’t support the plan benefits or claim experience.

        The main drivers of cost for the SEHBP prescription plan comes from GLP-1 and anti-inflammatory drugs.  GLP-1 drugs account for four of the top five drugs in terms of drug spend, while anti-inflammatory drugs make up four of the top 10 drugs based on drug spend.

        Although the report does not implicitly forecast exact rate actions for January 1, 2027, it does imply by the negative CSR forecast, continued double-digit trends and loss of membership that could signal a need for another significant high increase and/or major changes to existing plan designs.

        Benecard remains actively engaged in monitoring this situation and will continue to keep you informed of any updates related to the NJ SEHBP. If you have questions or would like to discuss, please reach out to us at talktous@benecard.com.

        Sources:

        1. https://www.nj.gov/treasury/pensions/documents/hb/rate-renewal/SEHBC-mid-year-analysis-presentation-PY2025.pdf
        2. https://www.nj.gov/treasury/pensions/documents/hb/rate-renewal/mid-year-analysis-local-edu-PY2025.pd
        NJ State Flag with US Flag behind it flowing in the wind. NJ Flag is yellow, blue and red.

        Update: Prescription Drug Plan Changes Approved for NJ SHBP-LG

        by Rx Insights

        (Effective July 1, 2026)

        On September 24, 2025, the NJ SHBP Plan Design Committee (PDC) met and approved several changes to the prescription drug plans for the State Health Benefits Program – Local Government (SHBP-LG).  The changes were initially planned for January 1, 2026, but were delayed. 

        On February 11, 2026, the PDC announced key updates to the previously approved SHBP-LG plan options, leading with the effective date which is now slated to be July 1, 2026.

        Key Updates

        For SHBP-LG Actives and Early Retirees, the plan design changes do not apply to the current plan options.  Instead, a new plan option was created that will be offered alongside the other available plans.  There were no changes to Medicare-eligible retirees.

        Effective July 1, 2026 the new plan offering will have the following plan design:

        • ● Non-diabetic GLP-1 drugs prescribed for weight loss will have a $45 copay per 30-day supply until the State implements a lifestyle management program. Once the program is active, members who participate will continue paying the $45 copay, while those who do not participate in a lifestyle management program will see their copay rise to $125 per 30-day supply. The implementation of this program is still uncertain at this time but intended to be available for July 1, 2026.
        • ● Generic drugs: $10 retail (per 30-day supply) / $10 mail order (90-day supply)
        • ● Preferred brand drugs: $20 retail (per 30-day supply) / $50 mail order (90-day supply)
        • ● Non-preferred brand drugs: $75 retail (per 30-day supply) / $150 mail order (90-day supply)
        • ● Specialty drugs: $75 (available through mail order only, up to a 30-day supply)

        In addition, mail order will become mandatory for all maintenance drugs. The resolution also sets new out-of-pocket maximums for prescription drug benefits: $2,120 for individuals and $4,240 for families. All other prescription benefits remain unchanged—such as mandatory generic, mandatory mail order for specialty drugs, step therapy, and an exclusionary formulary. 

        The new plan option provides for a 4.7% rate reduction off of the January 2026 renewal increase for the Rx for local government actives that enroll in the plan.  For the early retirees who enroll in this plan, the rate reduction is 2.9% off the January 2026 renewal increase.  These rates do include a 6% margin to help build the CSR balance plus an additional load to collect amounts owed under Chapter 86.

        Benecard will continue to closely monitor this ongoing situation and keep you updated on any further developments or communications related to the NJ SHBP-LG. In the meantime, if you have any questions on this topic, please email us at talktous@benecard.com.

        Sources:

        1 “SHBP PDC Resolution #2025-11”, NJ Treasury
        2 “State Health Benefits Program – July 2026 Premium Rate Update”, AON

        Close up of senior man's hands opening daily pill organizer

        What to Know About Oral Wegovy: Key Updates on Pricing, Dosage, and Administration

        by Rx Insights

        Following our recent blog article announcing the FDA approval of Novo Nordisk’s Wegovy® tablet and its introduction to the U.S. market, initial pricing from the manufacturer for the commercial market (i.e., employer sponsored plans) is consistent with the existing injectable formulation.

        Recent published media articles are stating the cost for the Wegovy oral tablet, depending on the dosage, range from approximately $149–$299 per month. These prices are based solely on those without insurance, otherwise referred to as self-pay cash paying customers. These prices are significantly lower than what the manufacturer charges to the commercial market.

        Dosage and Administration

        How will the Release of the Oral Tablet Impact Plan Sponsors?

        Despite the introduction of oral Wegovy, injectable GLP-1 therapies are expected to remain a core treatment option. Although the pricing for injectable Wegovy is not expected to change at this time, the entire GLP-1 market will evolve as competition intensifies, particularly with the anticipated launch of Eli Lilly’s oral GLP-1 candidate, orforglipron, and additional oral entrants that may influence future pricing strategies.

        With the marketplace now offering an oral alternative, overall GLP-1 utilization and access is expected to increase significantly and add to further cost pressures on plan sponsors. Benecard continues to develop a comprehensive GLP-1 strategy for its plan sponsors, adapting to the evolving GLP-1 marketplace. Understanding thoughtful and innovative benefit design, ongoing clinical oversight, and careful formulary alignment will be essential to ensure appropriate access, effective utilization, and sustainable outcomes for plan sponsors.

        Please contact your Benecard Client Relations Manager or Sales representative to learn about Benecard’s comprehensive GLP-1 strategy.

        Sources: