Daily Industry Report - April 1

Your summary of the Voluntary and Healthcare Industry’s most relevant and breaking news; brought to you by the Health & Voluntary Benefits Association®

Jake Velie, CPT
Vice Chairman, President & COO
Health & Voluntary Benefits Association® (HVBA)
Daily Industry Report (DIR)

Robert S. Shestack, CCSS, CVBS, CFF
Chairman & CEO
Health & Voluntary Benefits Association® (HVBA)
Daily Industry Report (DIR)

Biden administration rolls back extension of short-term plans

By Wire Reports - The Biden administration is cracking down on short-term health insurance plans that aren’t required to meet the Affordable Care Act’s consumer protection mandates. The U.S. Department of Health and Human Services issued a final rule rolling back a Trump-era policy that expanded what Biden called “junk” plans. Read Full Article…

VBA Article Summary

  1. New Regulations on Short-Term Health Insurance Plans: The final rules will restrict short-term, limited-duration insurance (STLDI) plans to a maximum of four months, a significant reduction from the previous limit of three years. These plans, which do not have to comply with the Affordable Care Act's consumer protections, serve to bridge temporary coverage gaps. The rules also mandate clear consumer notices for STLDI and "fixed indemnity" policies to improve transparency and prevent these plans from being mistaken for comprehensive coverage.

  2. Industry Reaction and Guidance: The National Association of Benefits and Insurance Professionals (NABIP) and the American Council of Life Insurers (ACLI) have responded to the new regulations. NABIP emphasizes the importance of professional advice in navigating health insurance options, advocating for a balanced approach that acknowledges the role of STLDI in the insurance market. ACLI appreciates that the rules preserve the sale of supplemental policies, highlighting their role in covering expenses not met by primary health insurance.

  3. Concerns and Opposition from Insurance Advisors: The National Association of Insurance and Financial Advisors (NAIFA) expresses concern over the new restrictions, suggesting a middle-ground approach might be more effective. NAIFA criticizes the characterization of STLDI plans as "junk insurance," arguing that such language could mislead consumers about the value of these policies during financially vulnerable periods. The association advocates for maintaining diverse STLDI options to protect American consumers adequately.

HVBA Poll Question - Please share your insights

What is your opinion on RWJBarnabas' decision to drop coverage for GPL-1 medications for weight loss among employees, as reported in the article referenced below?*

Login or Subscribe to participate in polls.

Our last poll results are in!


of Daily Industry Report readers who responded to our last polling question believe PBM practices like spread pricing and increasing hidden fees” is the primary factor contributing to the average 20% increase in pharmacy costs as a percentage of total medical spending for businesses. 

25.13% of respondents believe the primary factor for the increase in pharmacy costs is due to “higher utilization of specialty medications and a lack of resources for discounts on specialty medication,” 23.74% believe it’s due to “increased utilization of prescription drugs,” while 23.49% responded that “rising medication prices” is the main factor. 

Have a poll question you’d like to suggest? Let us know!

To penetrate crowded GLP-1 field, Rivus Pharma is taking a metabolic approach

By Amy Baxter - The weight loss drug space is booming, and drugmakers can’t make enough GLP-1s like Ozempic, Wegovy, Mounjaro and Zepbound to meet the soaring demand. But the market, which could be worth upwards of $200 billion in the next decade, is also crowded with pharmas and biotechs clamoring to add their own blockbuster hopefuls to the mix. Read Full Article…

VBA Article Summary

  1. Innovative Drug Development and Clinical Trials: Rivus Pharmaceuticals, led by CEO Dr. Jayson Dallas, is developing controlled metabolic accelerators (CMAs) as a new class of once-daily oral doses. These CMAs, including their lead candidate HU6 in phase 2 trials and a preclinical candidate RV-002 ANT-Activator, are notable for their effectiveness in clinical trials, comparable to GLP-1s but without their negative side effects. While Rivus is not targeting the weight loss market directly, its drugs are aimed at treating obesity alongside other conditions like fatty liver disease (MASH), heart failure with preserved ejection fraction, and Type 2 diabetes. The company is distinguishing itself by focusing on cardiovascular conditions rather than the cosmetic aspects of weight loss.

  2. Metabolic Approach to Treating Diseases: Rivus Pharmaceuticals' CMAs differ significantly from GLP-1 agonists by targeting the metabolic rate rather than mimicking glucagon-like peptide 1 hormones. This approach involves enhancing the body's metabolic rate to burn more calories and energy, thereby reducing fat and addressing cardiometabolic diseases without the muscle loss and reduced metabolic rate associated with GLP-1s. Dr. Dallas emphasizes the CMAs' ability to minimize muscle loss and inflammation, with a notable reduction in inflammation four times greater than other weight loss mechanisms for the same amount of weight lost.

  3. Strategic Expansion and Future Goals: Under Dr. Dallas's leadership, Rivus Pharmaceuticals is not only advancing its drug candidates towards commercialization but also relocating its discovery group from Charlottesville, Virginia, to San Francisco. This move aims to tap into a richer biotech talent pool and prepare for an eventual IPO, reflecting Dallas's long-term vision for the company. With $167 million raised in two fundraising rounds and the recent FDA approval of Madrigal Pharmaceuticals' Rezdiffra for MASH, Rivus sees a clear regulatory pathway and commercial potential for its innovative treatments.

Insurers are booming as ACA debate rages. What does the future hold?

By Noah Tong - The Affordable Care Act (ACA) is still a very big deal. That's how President Joe Biden described the landmark legislation on its 14-year anniversary Saturday, surrounded by President Barack Obama, former House speaker Nancy Pelosi and Department of Health and Human Services Secretary Xavier Becerra. Read Full Article…

VBA Article Summary

  1. Enrollment and Affordability Improvements: The administration reported a significant increase in the number of Americans enrolled in the Affordable Care Act (ACA) programs, with 21.4 million Americans enrolled after the recent open enrollment period. This marks a 31% increase from the previous year. It was also highlighted that 80% of Americans could find a plan for less than $10 a month, showcasing enhanced affordability. Enrollment in the online marketplace has seen a substantial rise from 8 million in 2014 to over 20 million in 2024, with 96% of individuals having options from at least three different issuers. The ACA's provision that prohibits insurers from rejecting coverage due to preexisting conditions was also emphasized as a key benefit.

  2. Financial Implications and Criticisms: Critics of the ACA pointed out the financial benefits insurance companies have gained since the law's enactment, with a 1,032% increase in the collective stock prices of major health insurers, significantly outpacing the S&P 500 ETF. The Paragon Health Institute reported that the program's cost to taxpayers is substantial, with each additional private insurance enrollee costing $36,798 and each non-group enrollee costing $20,739, which is more than triple the Congressional Budget Office's original projections. Additionally, concerns were raised about the increase in premiums due to the ACA's requirements, such as the single risk pool requirement and the cost-sharing assistance for silver plans.

  3. The Future of ACA and Ongoing Support: Despite criticisms and the potential for legislative challenges, there is strong support for the ACA from within the health insurance industry. The Biden administration's Inflation Reduction Act has extended enhanced federal subsidies through the end of 2025, offering short-term stability. Insurers like Oscar Health and Blue Cross Blue Shield expressed continued commitment to the ACA, emphasizing its role in delivering healthcare and improving the healthcare system. Oscar Health also highlighted the potential of individual coverage health reimbursement arrangements (ICHRAs) as a means to personalize healthcare for employees, suggesting a positive outlook for the ACA's role in fostering a competitive and consumer-friendly marketplace.

Biden administration finalizes rule cracking down on short-term plans

By Rebecca Pifer - Short-term health plans were originally designed as cheap safety-net coverage for just three months. However, in 2018 the Trump administration expanded their duration, part of a bevy of policies meant to weaken the Affordable Care Act exchanges. Read Full Article…

VBA Article Summary

  1. Biden Administration Tightens Regulations on Short-Term Health Plans: Finalizing a rule to limit the duration of short-term health insurance plans to a maximum of four months, the Biden administration seeks to reverse a Trump-era policy and address consumer protection concerns.

  2. Future Regulations Planned for Fixed Indemnity Plans: While the rule primarily focuses on short-term health plans, the Biden administration indicates future efforts to regulate fixed indemnity plans more stringently, alongside measures to prevent circumvention of duration limits and improve consumer transparency.

  3. Controversial Response to New Short-Term Plan Limitations: The decision to shorten the allowable duration of short-term health insurance plans has elicited mixed reactions, highlighting a divide between those advocating for consumer protections and critics warning of potential increases in the uninsured population.

Employer-Provided Health Plans Generate Major ROI for Companies, Employees

By AHIP  - More than half of all Americans – over 180 million hardworking individuals and their families – receive their health coverage through their jobs. Employer-provided coverage delivers affordable access to care, effective ways to improve health, and peace-of-mind. Read Full Article…

VBA Article Summary

  1. Substantial ROI from Employer-Provided Health Coverage: According to a study by Avalere Health, employers with 100 or more workers experienced a 47% return on investment in 2022 from offering health coverage, attributable to enhanced recruitment and retention, increased employee productivity, decreased medical costs and disability claims, and tax advantages. This ROI is projected to increase to 52% by 2026, with employers expected to see a return of $346.6 billion, including $108 billion from direct medical cost reductions and $139.70 billion in tax benefits.

  2. Benefits Beyond Financials: Providing quality, affordable health benefits is not only financially prudent but also aligns with doing right by employees, fostering loyalty, and retaining top talent. Alabama State Senator Lance Bell and Ray McCarty, president of Associated Industries of Missouri, emphasize that such offerings are crucial for private sector investment in the workforce, enhancing company competitiveness, and supporting a healthier, more productive workforce.

  3. Widespread Recognition of Health Coverage Value: From small businesses to large corporations, there is a broad acknowledgment of the positive impact of health coverage on employees and, by extension, on the companies themselves. This sentiment is echoed by business owners like Dwayne K. and supported by findings from an AHIP Coverage@Work survey, which indicates that health coverage is pivotal in employee recruitment and retention. The investment in health insurance benefits is highly valued by employees, contributing to financial peace of mind and overall well-being, which is particularly critical amidst challenges like high inflation and workforce shortages.

Industry Payments to Physicians Topped $12 Billion Over Nearly a Decade

By Sophie Putka - More than $12 billion in payments were made from industry to physicians from 2013 to 2022, an analysis of payment data showed. Read Full Article…

VBA Article Summary

  1. Extensive Industry Payments to Physicians: Over a period from 2013 to 2022, a study reported by Andrew Foy, MD, and colleagues in a JAMA research letter revealed that 826,313 of 1,445,944 eligible physicians received industry payments totaling $12.13 billion. These payments, which were heavily linked to marketed medical products (93.8%), included consulting services, food and beverages, and education among others. This highlights a substantial financial interaction between the medical industry and physicians.

  2. Impact and Concerns Regarding Physician-Industry Relationships: The study sparked discussions about the potential conflicts of interest arising from these relationships. Critics argue that such financial ties could negatively influence prescribing behaviors and adherence to professional guidelines, despite the existence of the OpenPayments database aimed at promoting transparency. The database's effectiveness in mitigating the influence of pharmaceutical and medical device industries on prescribing patterns remains debated among experts, with some advocating for more distant physician-industry relations to ensure unbiased patient care.

  3. Distribution and Specifics of Payments: The distribution of payments varied significantly across specialties and individual physicians. Orthopedic surgery, neurology and psychiatry, and cardiology were the top specialties in terms of total payments received, while payments to the median physician ranged from $0 to $2,339. The study also highlighted the top three drugs and medical devices associated with the highest industry payments, underscoring the financial magnitude of these relationships and the ongoing debate over their impact on medical practice and patient care.

10 drugs now in shortage

By Paige Twenter - Since March 20, 10 more drugs are either in short supply or discontinued — and the healthcare supply chain industry is watching whether the collapse of a Baltimore bridge might cause disruptions. Here are 10 new shortages, according to drug supply databases from the FDA and the American Society of Health-System Pharmacists. Read Full Article…

VBA Article Summary

  1. Pfizer and Medication Discontinuations: Pfizer has made significant changes to its medication offerings. It stopped manufacturing two azithromycin solutions early in 2024 for business reasons, after previously discontinuing two others in September. Additionally, Pfizer added a fifth solution of the antifungal drug, fluconazole (Diflucan), to its list of discontinued presentations, following the cessation of four solutions in 2023. Furthermore, Pfizer discontinued one solution of the skin infection treatment, linezolid (Zyvox), and has limited supply of two solutions of meperidine hydrochloride injection, a pain medication, with another on back order.

  2. Other Pharmaceutical Companies' Actions: Eli Lilly and American Regents are also adjusting their product lines. Eli Lilly discontinued two Humalog (insulin lispro injection) presentations, as reported by the FDA. American Regents is experiencing limited supply issues with two of its iron sucrose injection solutions, used for treating iron-deficiency anemia, although two are available. Additionally, Fresenius Kabi USA discontinued two solutions of pralatrexate, indicated for peripheral T-cell lymphoma.

  3. Shortages and Importations: The FDA has allowed for the temporary importation of riluzole oral suspension, a treatment for amyotrophic lateral sclerosis, with labels in Greek and Spanish due to shortages. As of late March 2024, shortages of two solutions ended, but the 50 milligram presentation remains unavailable without an importation deal. Furthermore, five solutions of nafcillin sodium injection, a penicillin antibiotic, are in shortage, while seven are not, with no release dates provided. Genentech discontinued three solutions of somatropin injection, a growth hormone therapy, citing the availability of generic and alternative treatments as the reason.

1 Year Later: How Has the Unwinding of Medicaid Continuous Enrollment Gone?

By Marissa Plescia - For about three years during the Covid-19 pandemic, a continuous enrollment provision was in place that prevented states from disenrolling Medicaid beneficiaries, regardless of whether or not they were still eligible for coverage. Read Full Article…

VBA Article Summary

  1. Impact of Ending Continuous Enrollment: The end of the continuous enrollment provision in Medicaid led to significant changes in Medicaid enrollment. As of March 26, 19.2 million people were disenrolled from Medicaid, while 40.6 million had their coverage renewed, and another 34.3 million were awaiting renewal. This shift occurred as states resumed the process of redetermining members' eligibility, a change that coincided with a record high enrollment of about 94 million people in Medicaid. The disenrollment rates varied greatly by state, with Utah experiencing the highest rate at 57% and Maine the lowest at 12%.

  2. Challenges and Successes in the Renewal Process: States faced historic challenges with Medicaid eligibility and enrollment systems, necessitating improvements and modernization. Despite these challenges, there have been successful outreach efforts, such as effective campaigns via paid media, text messages, and partnerships with community-based organizations. The transition from Medicaid to Marketplace coverage also saw notable success, with approximately 2.3 million people making the switch. However, the process was hindered by issues with the ex parte renewal process and communication barriers, particularly among Spanish speakers.

  3. Looking Forward: The massive undertaking of renewing Medicaid coverage for millions of members has highlighted the need for systemic improvements. About 70% of disenrollments were due to procedural reasons, indicating potential gaps in the renewal process and communication. Looking ahead, there are approximately 34.3 million renewals still pending. Lessons from the end of the continuous enrollment provision point to the necessity of streamlining the renewal process and reducing reliance on paper-based procedures to minimize coverage gaps and financial instability for Medicaid enrollees.

Young Adults With Migraine May Face Higher Stroke Risk

By Dennis Thompson - Migraines in young adults appear to increase their risk of stroke more than traditional risk factors like high blood pressure, a new study reports. Read Full Article…

VBA Article Summary

  1. Migraine as a Leading Non-Traditional Risk Factor: Research indicates that migraine is a significant non-traditional risk factor for strokes, especially among young adults aged 18 to 34, accounting for 20% of strokes in men and nearly 35% in women. This finding underscores the importance of considering non-traditional risk factors alongside traditional ones, such as high blood pressure and smoking, in assessing stroke risk among younger populations.

  2. Increased Stroke Risk from Non-Traditional Factors: The study reveals that non-traditional risk factors for stroke, including migraines, blood clotting disorders, kidney failure, autoimmune diseases, and cancer, are associated with a higher number of strokes in young adults compared to traditional risk factors. This shift highlights a changing landscape in stroke risk profiles, particularly among individuals younger than 35, where non-traditional risk factors accounted for about 31% of strokes in men and 43% in women.

  3. Urgent Need for Targeted Interventions: Dr. Michelle Leppert, the lead researcher, emphasizes the critical need to not only focus on traditional stroke risk factors but also to understand and address non-traditional ones. With strokes increasing among young adults who do not present traditional risk factors, there's a call to better comprehend the underlying mechanisms of non-traditional risk factors and to develop targeted interventions to mitigate stroke risk among young people effectively.

Cost of home health care services increased significantly, survey says

By Press Release - illumifin has just released its 2023 Cost of Care study and comprehensive analysis. Now in its tenth year, this longitudinal study includes national, state and regional costs of various care services, spanning skilled nursing, adult day care, home health care and assisted living facilities. Read Full Article…

VBA Article Summary

  1. Comprehensive Data Collection and Impact on Insurance and Care Provider Markets: Illumifin's Cost of Care study collects extensive data from care providers across the U.S., with the findings standardized by the company’s actuarial and data science teams. This comprehensive dataset is crucial for insurers and financial services providers for forecasting, stakeholder education, and advising customers and agents on national and regional cost variations in long-term care (LTC). Care providers also gain insights into market rates for their services, enhancing their understanding of competitive pricing within their local areas.

  2. Trends in Home Health Aide and Registered Nurse Costs: A Post-Pandemic Market Adjustment: The study revealed that the average hourly rate for a home health aide in 2023 was $30.62, marking a 5.2% increase from the previous year. Conversely, the average rate for a registered nurse visit fell to $147.72, showing a 1.6% decrease, which may indicate a market correction following pandemic-induced fluctuations. These findings highlight the dynamic nature of the healthcare services market, with rates adjusting as the sector stabilizes post-pandemic.

  3. Facility-Based Care Cost Dynamics: Regional Variations and Pandemic Influence Reversal: Analysis of facility-based care costs showed mixed trends: assisted living facilities saw a slight price increase of 0.6% to 3.8% in 2023, reversing the downward trend observed during the pandemic. On the other hand, skilled nursing facilities experienced a modest decrease in rates, ranging from 0.4% to 1.0%. The study also identified geographic disparities in costs, with the most expensive states for home health aides being Washington and New Hampshire, and for assisted living facilities, New Hampshire and New Jersey showcased the highest rates. Conversely, Mississippi and Louisiana for home health aides, and Alabama and Oklahoma for assisted living facilities, were among the least expensive states, underscoring the significant regional variation in care costs across the U.S.