TAMPA, Fla., Jan. 27, 2026 /PRNewswire/ -- Marpai, Inc. ("Marpai" or the "Company") (OTCQX: MRAI), a leader in innovative healthcare technology, Pharmacy Benefit Management (PBM) and Third-Party Administration (TPA) services, announced the hiring of Mimi Davis as President of MarpaiRx. Davis, a distinguished leader in the pharmacy services sector, will oversee the strategic expansion and operational scaling of Marpai's pharmacy benefit offerings. Davis joins Marpai from Knipper Health, where she served as E ...

This story was originally published on Healthcare Dive. To receive daily news and insights, subscribe to our free daily Healthcare Dive newsletter. Dive Brief: Cigna’s Express Scripts could be nearing a settlement with the Federal Trade Commission in the agency’s lawsuit accusing the largest pharmacy benefit managers in the U.S. of driving up insulin prices. The FTC has suspended proceedings against Cigna’s subsidiaries — including PBM Express Scripts, health services division Evernorth and group purc ...

Core Insights - The article discusses President Trump's unveiling of "The Great Healthcare Plan," which aims to reform the medical pricing structure by targeting kickbacks from pharmacy benefit managers (PBMs) [1][2]. Group 1: Healthcare Plan Overview - The plan seeks to reduce drug prices and insurance premiums by eliminating kickbacks paid by PBMs to large brokerage middlemen, which are seen as predatory fees that inflate costs for patients [2]. - The White House claims that these kickbacks "deceptively raise the cost of health insurance" and intends to redirect subsidies from large insurance companies to eligible Americans directly [2][3]. Group 2: Expert Validation - Independent analysis supports the administration's view on the PBM issue, with experts describing the PBM model as a "pay for play" system that prioritizes rebates over patient efficacy [4]. - Experts suggest that drug manufacturers would price their products significantly lower—up to five times less—if PBMs were removed from the pricing equation [5]. Group 3: Transparency and Accountability - The plan includes a "Plain-English Insurance" standard, requiring insurers to provide clear rate and coverage comparisons without complex jargon, addressing concerns about undefined terms that facilitate claim denials [6]. - The administration's push for "unprecedented accountability" indicates a potential confrontation with the healthcare lobby [6]. Group 4: Investment Opportunities - A list of top PBM operators and pharmaceutical ETFs is provided for investors considering opportunities in light of the ongoing healthcare reform discussions [7]. - Performance data for various stocks and ETFs is included, showing year-to-date and one-year performance metrics for companies like CVS Health Corp., Cigna Group, and UnitedHealth Group, as well as several pharmaceutical ETFs [8][9].

Core Viewpoint - Mark Cuban questions the control that insurance companies and Pharmacy Benefit Managers (PBMs) have over healthcare, suggesting they wield more power than federal authorities [1][5]. Group 1: Control and Influence - Cuban challenges the dominance of insurance companies and PBMs, implying that they have greater control over healthcare than government entities [1][3]. - He raises concerns about the reluctance of these companies to adopt innovative healthcare solutions like Grok and Optimus for their employees [2][5]. - Cuban argues that the regulatory capture by major players in the industry is more detrimental to healthcare than potential government interventions [3][5]. Group 2: Industry Debate - The discussion initiated by Cuban highlights a growing debate regarding the role of insurance companies and PBMs in healthcare, with critics asserting that these entities prioritize their interests over patient care [5]. - The comments also reflect the challenges faced by innovative healthcare solutions in gaining acceptance within the industry [6].

Group 1 - UnitedHealth Group Incorporated (NYSE:UNH) is undergoing operational changes due to audits of its health services and pharmacy benefit units, focusing on increased automation and standardization [1] - CEO Stephen Hemsley announced a comprehensive examination of managed care practices and pharmacy benefits, with 23 action plans already in progress, over half of which will be finalized by the end of this year [2][3] - UnitedHealth Group will share the results of the HouseCalls visit review in fiscal Q1 2026 [3] Group 2 - UnitedHealth Group reported that Optum Rx is modernizing pharmacy reimbursement methods, partnering with three additional Pharmacy Services Administration Organizations (PSAOs) to implement cost-based contracts for over 17,000 community pharmacies [4] - The initiative aims to better support community pharmacies, with 100% of community and independent pharmacies in the Optum Rx network transitioning to the new reimbursement model [5] - UnitedHealth Group operates through various segments, including OptumRx, OptumInsight, OptumHealth, and UnitedHealthCare, providing healthcare coverage, data consultancy, and software services [5]

Core Viewpoint - CVS Health has become a leading performer in the healthcare sector under CEO David Joiner, with stock prices increasing by 2% following the announcement of optimistic long-term earnings targets [1]. Group 1: Company Transformation and Strategy - CVS Health is focused on transforming healthcare delivery in America, emphasizing consumer engagement and improved relationships with healthcare providers through technology [2][3]. - The company aims to enhance operational efficiency and productivity while addressing consumer frustrations regarding healthcare costs and navigation [5][4]. - CVS Health has set ambitious long-term growth targets, projecting a compound annual growth rate (CAGR) of 15% by 2028, with a commitment to delivering on promises made to stakeholders [6][7]. Group 2: Business Performance and Recovery - Over the past year, CVS Health has successfully stabilized its business, particularly in the retail sector, which has shifted from a decline of 5% to a growth trajectory [11]. - The company has reported consistent performance improvements, having beaten and raised guidance for four consecutive quarters [7][20]. - CVS Health is positioning its retail business as a gateway to other enterprise services, leveraging consumer trust to enhance overall healthcare delivery [12]. Group 3: Healthcare Cost Management - CVS Health is addressing the high costs associated with rare diseases, which represent 2% of the population but account for 50% of healthcare spending, by managing pharmacy benefits and introducing competition to lower costs [15][18]. - The average price for new branded medications is reported to be $350,000, highlighting the need for affordable solutions in the healthcare market [16]. Group 4: Role of Pharmacists - CVS Health is focusing on maximizing the role of its 30,000 pharmacists, aiming to utilize them as primary care providers to address access issues in healthcare [22][24]. - The company believes that elevating the role of pharmacists will enhance patient care and strengthen consumer relationships [24].

Core Insights - CVS Health has raised its full-year earnings forecast and introduced an AI strategy to enhance engagement [1][6] Financial Outlook - CVS now expects full-year adjusted earnings per share (EPS) of $6.60 to $6.70, an increase from the previous forecast of $6.55 to $6.65 [2] - The company anticipates revenue of at least $400 billion, up from the earlier outlook of at least $397.3 billion [2] - For fiscal year 2026, CVS projects adjusted EPS of $5.94 to $6.14 on revenue of at least $400 billion [2] Business Performance - Strong earnings growth at Aetna and an increase in new customers for its pharmacy-benefits business contributed to the improved outlook [3] - CVS CFO Brian Newman indicated that the company is closing out 2025 with significant momentum and expects continued strong earnings growth in 2026 [3] Strategic Initiatives - CVS has outlined a new engagement plan that includes developing a platform with AI capabilities to integrate various healthcare components into a single app [5] - The company's shares have increased by approximately 75% this year, although they remain below their highs from 2022 [5] Investor Confidence - The improved outlook may enhance investor confidence in CVS's turnaround efforts under new CEO David Joyner, who took over in October amid challenges such as rising medical costs and reduced store foot traffic [4]

Core Insights - Marpai, Inc. has demonstrated significant positive momentum with a better-than-expected sales cycle for 2026 and the renewal of its network access agreement with Aetna [1][2][3] Group 1: Sales and Growth - The company reports a robust sales cycle, securing a volume of new clients for January 1, 2026, that surpasses internal expectations, reinforcing its path to scalable growth and previously guided profitability targets [2] - The success of the 2026 sales cycle, coupled with the renewal of the Aetna Signature Administrator network agreement, sets a strong foundation for the year ahead [5] Group 2: Network and Cost Management - Marpai has successfully renewed its agreement to access the Aetna Signature Administrator (ASA) PPO network, ensuring broad, national access to Aetna's extensive network of high-quality providers for its self-funded employer clients [3] - The introduction of the Aetna Faircost Optimizer as an integrated cost management tool will help plan sponsors manage out-of-network claims costs effectively, enhancing Marpai's ability to deliver superior cost containment [4] Group 3: Company Overview - Marpai, Inc. operates in the $150 billion TPA sector, serving self-funded employer health plans that represent over $1.5 trillion in annual claims [6] - The company focuses on delivering value-oriented health plan services and operates nationwide, offering access to leading provider networks including Aetna and Cigna [6]

Core Insights - Curaechoice has partnered with CVS Caremark as its pharmacy benefit manager, aiming to reduce prescription drug costs for its members [1][2] - The collaboration will enable Curaechoice members to access CVS Caremark's extensive network of 65,000 pharmacies starting January 1, 2026 [1] - The partnership is expected to help self-insured employers manage healthcare spending while providing quality care to employees [3] Company Overview - Curaechoice specializes in No-Cost Benefits Optimization, focusing on providing comprehensive healthcare solutions without copays, deductibles, or co-insurance [4] - CVS Caremark, a subsidiary of CVS Health, is recognized for its innovation and affordability in prescription drug delivery, operating a broad network of retail and mail-order locations [4] Market Context - Pharmacy costs account for nearly one-third of an employer's total healthcare spending, highlighting the significance of the partnership in addressing rising healthcare expenses [2] - The collaboration is positioned as a response to the increasing financial pressures faced by families, including costs related to groceries, gas, childcare, and healthcare [3]

Core Insights - Eli Lilly's CEO, Dave Ricks, criticized pharmacy benefit managers (PBMs) for inflating insulin prices, claiming they create a detrimental incentive structure that leads to high list prices while the net price remains low [1][2][5] - Ricks highlighted that the list price for Lilly's insulin reached $275, while the actual net price was around $40, indicating a significant disparity caused by PBMs profiting from the price spread [2][3] - The company's response to this issue included launching a low-priced "shadow generic" insulin, which faced pushback from PBMs, prompting the creation of LillyDirect, a direct-to-consumer platform to bypass the PBM system [3][5] Industry Context - Mark Cuban, founder of Cost Plus Drugs, echoed Ricks' sentiments, describing PBMs as having a "stranglehold" on pricing and contributing to inflated healthcare costs [4][5] - Both Ricks and Cuban's criticisms suggest a growing challenge to the PBM business model, which is perceived to inflate costs for vulnerable patients [5] Stock Performance - Eli Lilly's stock closed at $988.62, reflecting a year-to-date increase of 27.06% and a one-year increase of 20.73% [6] - The stock has shown a strong price trend across short, medium, and long terms, despite a poor value ranking [6] PBM and Pharma ETF Performance - Notable performances of PBMs and pharmaceutical ETFs include: - CVS Health Corp. with a year-to-date performance of 80.62% and one-year performance of 47.83% - Cigna Group with a year-to-date performance of -2.36% and one-year performance of -21.15% - UnitedHealth Group with a year-to-date performance of -35.10% and one-year performance of -46.73% [7] - Various pharmaceutical ETFs also showed positive year-to-date performances, with the Invesco Pharmaceuticals ETF at 22.30% and the KraneShares MSCI All China Health Care Index ETF at 37.64% [8]