Fifty-six percent of employer clients of “Big Three” pharmacy benefit managers — CVS Caremark, Cigna’s Express Scripts and UnitedHealth Group’s Optum Rx — are thinking about switching in the next one to three years.
The 2026 “Pulse of the Purchaser” survey, released Aug. 11 by the National Alliance of Healthcare Purchaser Coalitions, included 408 responses from employers. The survey ran in May and June.
Here are six things to know from the survey:
Of clients using alternative PBMs, 31% are considering a change in the next few years.
The share of employers relying on the Big Three dropped from 63% in 2025 to 54% in 2026.
Employers with fewer than 1,000 workers are primarily responsible for these shifts away from the Big Three PBMs, with the Big Three share dropping from nearly 70% of those employers in 2025 to 44% in 2026.
Out of the 27 employers who migrated to a different PBM in the last year, only seven now use one of the Big Three.
Almost 39% of Big Three users reported higher-than-average premiums, versus nearly 28% of those using other PBMs.
Nearly one-quarter of Big Three clients were not aware of what was in their contracts, versus 12% of clients using other PBMs.
Participation in mandatory value-based payment programs from CMS is associated with significantly higher annual administrative costs for hospitals, according to astudypublished Aug. 7 in JAMA Health Forum.
Researchers at the Brown University School of Public Health in Providence, R.I., examined 2006 to 2020 Medicare cost report data for 4,332 hospitals, including 2,820 that participated in the Hospital Value-Based Purchasing program, Hospital Readmissions Reduction Program and Hospital-Acquired Condition Reduction Program. They also assessed costs associated with participation in the Comprehensive Care for Joint Replacement model.
Researchers compared administrative costs among hospitals participating in these programs to three groups exempt from the programs: general acute care hospitals in Maryland (paid under the state’s separate all-payer model), critical access hospitals and long-term acute care hospitals.
Participation in the first three programs was tied to annual administrative cost increases ranging from $650,000 per hospital compared with long-term acute care hospitals to $1.23 million compared with general acute care hospitals in Maryland. Participation in the CJR model was linked to a $1.4 million annual increase in administrative costs per hospital.
Aggregated nationally, the programs accounted for more than $3 billion in additional annual administrative spending.
“These findings suggest that hospitals may have expanded administrative staffing and workflows to meet the requirements of value-based payment programs, including reporting, care coordination, data management and analytics, and clinical documentation and risk adjustment,” researchers wrote.
The increases were more pronounced at hospitals with higher Medicare Advantage penetration and in states that expanded Medicaid, the study found.
The results carry added weight for hospitals bracing for CJR-X, the first mandatory, nationwide episode-based payment model for joint replacements set to launch Jan. 1, 2028.
Mayor Zohran Mamdani plans to boot cars from swaths of The Bronx’s East Tremont Avenue in a bid to speed up city buses — but local drivers blasted the move as “crazy” on Wednesday.
Starting Sept. 19, cars will largely be banned from sections of the six-mile corridor between the hours of 6 a.m. and 8 p.m., with the exception of large trucks, access-a-ride vans and emergency vehicles.
“Thanks to our historic bus action plan, City Hall is bringing the Tremont Avenue busway back to life,” Mamdani said Wednesday at Walter Gladwin Park, as he announced the city was breaking ground on the long-stalled project.
“New Yorkers will feel this change almost immediately,” he vowed, as City Hall officials claimed the project would make Bx36 bus service faster and more reliable.
But drivers will feel the change the most, Bronx motorists said.
“It would be a problem for everybody!” one local, who gave his name as Hector, 66, said as he waited in his car to pick his wife up from work along East Tremont Avenue.
The Mamdani voter said the mayor should “to remember who put him here” before implementing the dramatic changes.
Even bus rider John Beuther, 79, thought the plan was “crazy.”
“Everybody drives up here,” he said adding that the bus on the avenue — which City Hall estimated had an average speed of 5 mph during rush hours — was already fast enough.
“I’ve gotten the bus along here a few times. They’re already pretty fast,” he said.
Julio Martinez, 38, owns Chon Barbershop on East Tremont Avenue and parks in front of his barber shop each day, as do his customers. He said the changes could hurt his business.
“Everybody’s driving,” Martinez said. “We’re gonna lose a lot of money. No one’s gonna come and get a haircut.”
Former Mayor Eric Adams’ administration paused the busway project in 2025 saying it did not have enough community support,NY1reported at the time.
Mamdani put the plan back on track, claiming the changes will improve bus speeds by up to 60%, saving riders up to six minutes per trip and increase safety for make pedestrians and bikers.
Under the plan Eastbound buses will get the busway from Third Avenue to Southern Boulevard along Tremont Avenue, while westbound buses get it from Southern Boulevard to Belmont Avenue. NYC DOT / Facebook
Eastbound buses will get the restricted path from Third Avenue to Southern Boulevard, an about 10-block stretch, while westbound ones get the busway for the about three blocks from Southern Boulevard to Belmont Avenue.
Allan Rosen, vice chair of transit advocacy group Passengers United and a former bus planner for the MTA with decades of experience, told The Post he was skeptical of the promise that the Bx36 will be faster.
“I don’t believe any DOT (Department of Transportation) promises. They promised 30% faster travel times in 2016 for Woodhaven Blvd bus lane and SBS and got slower travel times,” Rosen claimed.
Mamdani took a swipe at drivers, accusing those who find themselves in the bus lane of “deliberately trying to slow down our buses.”James Keivom for NY Post
Mamdani, during Wednesday’s press conference, took a swipe at drivers, accusing those who find themselves in the bus lane of “deliberately trying to slow down our buses.”
He said he wants to slap drivers with more big-brother style camera tickets through the MTA’s Automated Camera Enforcement program, which used to be called ABLE.
“One critical part of this is also ACE and ABLE, and ensuring that we are expanding the number of miles across the city, where we are able to hold those accountable, who are deliberately trying to slow down our buses by being in those very lanes,” Mamdani said.
Mamdani touted afaster bus planin Brooklyn earlier this summer that relies on speeding up buses by removing stops.
The politicians said the DOT’s redesign plan didn’t include basic neighborhood upgrades or bring back much-needed bus stops that were removed to speed up the buses.
A busway is a street where buses get to go straight through, while regular cars can only enter briefly to reach a local destination and then must turn off.
A federal appeals court has ruled that the government’s methodology for calculating the qualifying payment amount within the No Surprises Act’s arbitration process is partly unlawful, a decision that could force insurers to recalculate QPAs and raise some benchmark payments.
In the Aug. 11 decision, a majority of the Fifth Circuit’s 17 active judges sided with the Texas Medical Association and other plaintiffs on two of three challenges to rules previously issued by HHS and the Labor and Treasury Departments in 2021. The court found the agencies violated the statute by allowing insurers to include so-called “ghost rates” in QPA calculations and by excluding bonus and incentive payments. The judges upheld the agencies’ exclusion of single-case agreements, such as those common in air ambulance billing.
Ghost rates are non-negotiated placeholder rates that sit in insurer-provider contracts for services a provider typically doesn’t perform. An OB-GYN who does not deliver babies, for example, might still have a contract that includes rates for obstetrical services at little or no cost. Because providers have no incentive to negotiate those rates, they can be as low as $1, so including them in QPA calculations pulled the benchmark down.
A lower court previously found the agencies’ rules allowed insurers to include rates for services “that are not provided, never have been provided, and never will be provided.” The Fifth Circuit agreed, writing that the rules had “upended” the IDR process. The court noted that arbitrations have far exceeded original federal projections, providers have prevailed in more than 80% of resolved disputes and arbitrators are choosing a rate above the QPA in 85% of decisions.
The agencies had also skipped the standard notice-and-comment rulemaking process when writing the original 2021 rule, then tried to fix the $0 ghost rate problem through an informal FAQ document.
“So it is awkward, to say the least, for the agencies now to complain that they do not have sufficient information from providers,” the court wrote.
On bonus payments, the court found the agencies could not categorically exclude bonus, incentive and other payment adjustments connected to the relevant item or service, as doing so could omit part of the required “total maximum payment.” For air ambulance companies, the court sided with the government, finding that one-off emergency billing agreements are not “contracted rates” under federal law.
The court said the agencies can use their enforcement discretion to let insurers keep using existing QPAs while new calculations are completed, preserving balance billing protections for patients in the interim.
The decision arrives as major insurers have been escalating their public criticism of the IDR system, with leadership at Aetna, Cigna and UnitedHealthcare in recent weeks describing “abuses” of the IDR system by providers or calling for major reforms to the process. UnitedHealthcare told Becker’s it now sees about 100,000 disputes a month, far beyond the 22,000 a year CMS originally projected across the entire system.
Providers won 85% of the 1.15 million disputes that received payment determinations in the second half of 2025 and awards exceeded the QPA in 87% of those cases, according to federal data.
Southern Poverty Law Center (SPLC) executive Heidi Beirich was arrested in California on Wednesday under a superseding indictmentin the Justice Department's ongoing case against the organization, according to a CNNreportconfirmed by federal officials.
Beirich, who directed the Southern Poverty Law Center's Intelligence Project until 2019, faces three counts: conspiracy to commit wire fraud, conspiracy to submit false statements to a federally insured bank, and conspiracy to conceal money laundering. She was expected to make an initial appearance in Riverside later Wednesday.
"I believe she was part of the effort to open bank accounts in completely fictitious companies' names and make payments to individuals for reasons that were not accurate as described," Attorney General Todd Blanche told reporters Wednesday. "This is exactly what we said would happen in a case like this."
At the center of the allegations is an SPLC program that paid informants embedded in extremist organizations the nonprofit publicly monitored and campaigned against. Prosecutors allege Beirich helped oversee those payments and shared a bank account with one of the informants receiving them.
That informant, identified in charging documents as F-9, allegedly infiltrated the neo-Nazi National Alliance. Prosecutors further allege that Beirich was living with him and romantically involved with him while the payments were being made.
Reporting on the June superseding indictment said roughly $140,000 in donor funds moved from the SPLC's operating account into joint accounts held by Beirich and F-9 between 2015 and 2021. The organization is also alleged to have paid the informant more than $1 million since 2007.
Other payments under the same program allegedly went to separate recipients. The indictment, for example, describes funds reaching an Imperial Wizard of the United Klans of America - a different individual from the informant with whom Beirich allegedly had a relationship.
According to prosecutors, F-9 also broke into the headquarters of a white supremacist organization and removed approximately 25 boxes of documents. Those materials allegedly became the basis for a 2015 Hatewatch article written by Beirich titled "Chaos at the Compound." A second informant was allegedly paid about $6,000 to take responsibility for the burglary and conceal the identity of the original source.
An attorney for Beirich denied wrongdoing, calling the case meritless and politically motivated and saying she looks forward to presenting her side in court. An SPLC spokesperson had no immediate comment.
The SPLC has contested the government's case from the beginning, arguing that prosecutors are mischaracterizing a long-running intelligence-gathering program designed to monitor violent extremists. Its attorneys have also emphasized that law-enforcement agencies made use of information generated by SPLC informants.
Initial Indictment
A federal grand jury in Montgomery indicted the SPLC on April 21 on 11 counts: six of wire fraud, four of bank fraud, and one of money laundering.
Prosecutors allege the organization funneled more than $3 million in donated funds to at least eight informants associated with groups including the Ku Klux Klan, Aryan Nations, the National Alliance, and the National Socialist Party of America between 2014 and 2023.
According to the indictment, some of those payments were routed through bank accounts opened in the names of fictitious entities such as Rare Books Warehouse and Tech Writers Group.
"The SPLC is manufacturing racism to justify its existence," Blanche said when the original charges were announced.
The SPLC pleaded not guilty in July and moved to dismiss the indictment, arguing that the prosecution was vindictive and that the administration was retaliating against the organization for identifying and criticizing extremist groups.
On Aug. 7, U.S. District Judge Emily Marks rejected that motion, finding that the SPLC had not demonstrated prosecutorial animus. We covered that ruling here, as well as the unusual timing of an Atlantic story targeting FBI Director Kash Patel three days before the original indictment here.
The FBI severed its relationship with the SPLC in October 2025. In its most recent available filing, the organization reported gross receipts of $339.3 million and assets totaling $822.2 million.
At a June 9 House Judiciary Committee hearing titled "Manufacturing Hate, Part II," witnesses testified that the SPLC's "hate group" designations had been used as screening criteria by payment processors, donor-advised funds, corporate-giving platforms, and web-hosting companies.
In practice, witnesses argued, the SPLC's privately maintained list could carry consequences resembling those of an official government designation, despite there being no formal due-process mechanism for organizations placed on it.
One witness told the committee that his organization lost access to charitable-giving platforms, web hosting, and nonprofit software pricing after appearing on the SPLC's hate map.
Those claims remain witness characterizations rather than judicial findings. But they are now part of the congressional record, and the fact that federal law-enforcement agencies previously relied on intelligence produced by the SPLC is not in dispute.
Beirich left the SPLC in 2019 amid the upheaval that followed the firing of co-founder Morris Dees and the departure of much of the organization's senior leadership. She later co-founded the Global Project Against Hate and Extremism, where she continued working as an extremism researcher.
New Orleans is testing just how much Americans are willing to trust artificial intelligence when the stakes are considerably higher than writing an email or ordering dinner,according to the New York Post.
The city has begun allowing an AI system to field certain 911 calls, apparently making it the first major U.S. municipality to put a bot directly between emergency callers and human operators.
The idea is largely about volume. New Orleans' emergency communications center receives more than 1,000 calls on a typical day, and officials believe automation can clear some of the clutter while dispatchers concentrate on genuine emergencies.
The technology isn't supposed to take over the entire 911 operation. Instead, it can deal with situations that appear redundant or relatively routine when human operators are tied up. A flood of calls about the same already-reported car accident, for example, could potentially be filtered through the automated system rather than occupying multiple dispatchers.
The Post writes that city officials insist humans remain at the center of the operation. But skeptics say emergency calls are precisely the kind of messy, unpredictable interactions computers may struggle to interpret.
People dialing 911 aren't reading from scripts. They may be terrified, whispering, intoxicated, injured, confused or speaking through heavy background noise. In some situations, callers intentionally conceal what's happening because another person is nearby.
One online critic who identified himself as a former 911 dispatcher called the experiment “the worst idea you could possibly think of,” arguing that experienced operators routinely listen for clues beyond the caller's literal words.
That concern becomes more significant given the continuing reliability problems surrounding conversational AI. Voice models can confidently produce incorrect information, while cybersecurity researchers have shown that specially constructed audio can sometimes manipulate AI systems into behaving in unintended ways.
New Orleans isn't alone in bringing algorithms into emergency services. Atlanta uses AI technology to assist operators in locating callers, while Seattle has used automated tools to help sort medical calls by urgency. The distinction is that New Orleans appears to be going further by allowing AI to actually interact with some people dialing 911.
Officials believe safeguards, human supervision and strict limits on when the system is activated can make the technology useful without handing emergency response over to a machine.
It's an ambitious experiment, although perhaps an uncomfortable one: the next time somebody calls 911 in New Orleans, the first voice answering may not belong to a person at all.
A new report found that Americans are continuing to get bombarded by robocalls, with more than 4 billion recorded in July, according to blocking service YouMail.
There were 4.3 billion robocalls received across the United States last month, said YouMail in a news release.
On average, July saw 139.3 million robocalls per day and 1,612 robocalls per second, which is slightly lower than the 141.8 million robocalls per day, and 1,642 calls per second recorded in June.
Unwanted robocalls also increased by nearly 6 percent in July 2026 as consumers received more than 2.1 billion such calls that month, it said.
According to the report, about 51 percent of robocalls were likely wanted, and 49 percent were likely unwanted.
"Monthly robocall volumes have been slowly creeping upward, and we're more than 15 percent above the lowest levels we saw last October," said YouMail CEO Alex Quilici in a statement, noting "the dangers of scam calls" despite robocall activity being "much lower than historic levels."
YouMail said that the "most problematic robocall campaigns" in July revolved around pre-approved loan officers that claim to inform a consumer that they have qualified for a loan with relatively low monthly payments.
"Hi, this is Cornelius about your recent personal loan inquiry," said an example of a robocall on loans, provided by the company.
"I'm happy to share that you've qualified for up to $45,000 with monthly payments around $575. I want to take a few minutes to go through the details with you and answer any questions before we get the paperwork started."
That campaign, YouMail said, originated from thousands of separate phone numbers and used a "small set of recurring caller names" with different loan amounts, payment terms, and contact numbers.
More than 40 million calls were generated from the campaign last month, according to YouMail.
Consumers, meanwhile, have reported the loan-related calls as likely spam and said they never asked about or applied for a loan.
According to YouMail, area codes in the United States that saw the largest increases in robocalls in July were: area code 346 in Houston, Texas; area code 470 in Atlanta, Georgia; area code 229 in Albany, Georgia; area code 765 in Indianapolis, Indiana; area code 901 in Memphis, Tennessee; area code 812 in Evansville, Indiana; area code 720 in Denver, Colorado; area code 870 in Jonesboro, Arkansas; area code 931 in Clarksville, Tennessee; and area code 254 in Killeen, Texas.
"As with similar campaigns, this appears to be, at a minimum, illegal telemarketing at scale," the company said. "Based on consumer reports and the behavior of the calls, it's likely to be a scam."
Earlier this month, a bill to reduce robocalls passed in the Senate that cracks down on calls originating from outside the United States.
"As foreign robocallers step up their efforts to exploit and prey on vulnerable people, we need to do more to combat this unlawful practice and protect Americans from scams," said Sen. Peter Welch (D-Va.) in a statement.
Consumers can opt into the National Do Not Call Registry, a federal government database that lists phone numbers of people who have requested that telemarketers not contact them.
