Defense funding push reopens door for stalled ICHRA, HSA reforms

By Allison Bell – Republican leaders in Congress are trying to come up with $200 billion in funding for U.S. military action in Iran. That could create a new chance for supporters of individual coverage health reimbursement arrangements and health savings accounts to get ICHRA and HSA provisions through Congress. The vehicle would be a "budget reconciliation bill," or a special kind of bill that can move through the Senate with just 51 votes, rather than the 60-vote majority normally required for ordinary bills. House Budget Committee Chairman Jodey Arrington, R-Texas, has proposed squeezing $30 billion out of Affordable Care Act funding by using a reconciliation bill to change the ACA cost-sharing reduction subsidy. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Defense Funding as a Catalyst for Health Reform: The urgent need to raise $200 billion for military action in Iran has prompted Congressional leaders to consider budget reconciliation as a legislative vehicle. This process allows certain bills to pass the Senate with a simple majority, bypassing the usual 60-vote threshold. As a result, previously stalled health policy changes, such as reforms to ICHRAs and HSAs, may have a renewed opportunity for passage.

2. Potential Changes to ACA Subsidies and Health Accounts: Proposals under discussion include altering the Affordable Care Act's cost-sharing reduction subsidies, which help low-income individuals with out-of-pocket costs. Additionally, lawmakers are considering reviving health provisions that were previously removed from the One Big Beautiful Bill Act, such as increasing HSA contribution limits and allowing older workers to make additional contributions. These changes could significantly impact both employers and employees by expanding options for health coverage and savings.

3. ICHRA and CHOICE Arrangement Developments: One of the most notable provisions that could be revived is the establishment of a federal statute for ICHRAs, potentially rebranding them as Custom Health Option and Individual Care Expense arrangements. This would give employers more flexibility, allowing workers to choose between cash-for-coverage plans and traditional group health plans. If enacted, these reforms could broaden the ways employers support employee health coverage and provide more individualized options for workers.

CVS Caremark, BCBS overcharged federal employee health plan $615M: Audit

By Jakob Emerson – CVS Caremark and the Blue Cross Blue Shield Association overcharged the Federal Employees Health Benefits Program by a total of $615 million in pharmacy pricing between 2018 and 2021, according to a final audit report published by the Office of Personnel Management’s Office of Inspector General on March 13. The audit looked at whether costs charged to the FEHBP and services provided to its members aligned with OPM’s contract and federal regulations. The auditors reviewed administrative fees, annual accounting statements, claims eligibility and pricing, drug manufacturer rebates, fraud and abuse programs, and performance guarantees for the four-year period. Read Full Article...

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1. Largest Audit Finding on Discount Pass-Through: A federal audit identified $478.7 million in questioned costs related to CVS Caremark’s handling of pharmacy discounts for the Federal Employees Health Benefits Program (FEHBP). Auditors reported that Caremark did not fully pass through certain discounts negotiated with two large national pharmacy chains and instead applied less favorable rates to FEHBP claims. The report also indicated that some commercial clients received better discount terms, particularly for generic medications.

2. Transmission Fee Handling Identified in Second Finding: The audit reported a $108.6 million finding related to transmission fees that CVS Caremark collected from retail pharmacies. According to the Office of Inspector General (OIG), Caremark reduced payments to pharmacies by these fees while still billing the Blue Cross Blue Shield Association (BCBSA) the full cost of the drugs. Auditors concluded that the difference was retained by Caremark rather than being passed through to the federal health plan.

3. Performance Incentive Payment and Contract Dispute: A third finding of $27.8 million involved a performance incentive paid to Caremark when pharmacy spending fell below a pricing guarantee threshold. The OIG reported that BCBSA issued the incentive payment without verifying that transparency and discount pass-through requirements had been met. BCBSA and CVS Caremark disputed the findings, arguing the audit applied updated contract standards retroactively, while the OIG stated that the transparency requirements had been in place since 2011.

Nearly half of US hospital markets entirely controlled by 1 or 2 health systems: KFF

By Dave Muoio – In 2024, 47% of U.S. metropolitan areas had their entire inpatient hospital market under the control of just one or two health systems, according to a recent KFF analysis that raises new red flags around consolidation and rising healthcare prices. Additionally, 83% of metropolitan areas had more than three-quarters of their markets controlled by one or two health systems. And, echoing similar recent research into the topic, hospital markets became less competitive over the prior decade and almost uniformly meet antitrust regulators’ general threshold for high market concentration. Read Full Article...

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1. Hospital Market Consolidation Is Widespread Across U.S. Metropolitan Areas: A KFF analysis using 2024 RAND Hospital Data and American Hospital Association survey data found that hospital markets across the country are highly concentrated. The report shows that 19% of Metropolitan Statistical Areas (MSAs) are entirely controlled by a single health system and another 27% are controlled by two systems, while a single system controls at least half of the market in 76% of MSAs. Overall, 97% of MSAs have a Herfindahl-Hirschman Index (HHI) above 1,800—the federal threshold for highly concentrated markets—indicating limited competition in most hospital markets.

2. Smaller and Rural Markets Experience Higher Levels of Concentration: The report found that consolidation is more pronounced in less populated areas, where fewer competing health systems operate. Nearly four out of five MSAs with populations under 200,000 have inpatient hospital markets fully controlled by one or two systems. In contrast, all but one of the 55 MSAs with populations of at least 1 million have four or more competing systems, although in 14 of these larger markets the two largest systems still control about 75% of hospital market share.

3. Provider Consolidation Has Increased Over Time and Remains a Policy Debate: According to American Hospital Association data, the share of hospitals affiliated with larger health systems rose from 56% in 2010 to 80% in 2024, with market concentration increasing in 80% of metropolitan areas between 2015 and 2024. Some policymakers and insurers argue that consolidation reduces competition and contributes to higher healthcare prices and spending, citing research linking provider consolidation to increased Medicare and commercial costs. Hospital industry leaders contend that mergers can lower operating costs by an average of 3.3% and improve quality outcomes, though critics and lawmakers continue to question those claims and call for policies to limit further consolidation.

Medicare Advantage overpayments are costing traditional Medicare, too

By Maia Anderson – Overpayments to Medicare Advantage (MA) plans has been a widely known issue for years. But overpayments don’t just raise spending in MA—they lead to higher spending in traditional Medicare as well, according to a report released March 10 by the Joint Economic Committee. MA overpayments raise spending in Medicare Part B, which covers outpatient services such as doctor’s office visits and diagnostic tests. Premiums equal 25% of overall spending in Part B, so increased spending means increased premiums, Paul Ginsburg, senior scholar at USC’s Schaeffer Institute and nonresident senior fellow at the Brookings Institution, told Healthcare Brew. Read Full Article...

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1. MA Overpayments Increased Part B Premiums and Insurer Revenues: Overpayments to Medicare Advantage (MA) plans increased Medicare Part B premiums by about $212 per beneficiary in 2025, totaling roughly $13.4 billion, according to the Joint Economic Committee. Federal analysts also estimated that inflated risk adjustment scores contributed approximately $7.5 billion in insurer profits in 2023. Overall, a July 2025 analysis by KFF estimated that MA insurers received about $84 billion in overpayments in 2025.

2. Overpayments Linked to Favorable Selection and Coding Practices: Analysts attribute most MA overpayments to favorable selection and coding intensity. Favorable selection occurs because MA enrollees tend to be healthier than those in traditional Medicare, often leading to lower healthcare spending. Coding intensity refers to MA plans documenting more diagnosis codes for beneficiaries, which increases risk scores and raises the payments insurers receive from Medicare.

3. Lower Proposed Payment Rate Could Affect Insurers and Plan Benefits: CMS has proposed a 0.9% payment rate increase for Medicare Advantage plans in 2027, compared with an average increase of 5.06% for 2026. Some insurers have expressed concern about the smaller increase, although experts note that many plans have received significant overpayments in prior years. Researchers also note that if payment rates remain lower, insurers may reduce supplemental benefits such as fitness or grocery programs, though plans often absorb some financial changes to limit impacts on beneficiaries.

Novo Nordisk to launch discounted Wegovy subscriptions for self-pay patients in US

By Maggie Fick – Novo Nordisk will launch a discounted subscription plan for U.S. Wegovy patients ‌paying for the drug themselves, offering monthly prices up to nearly 30% below its standard rate as it tries to widen access and regain ground from Eli Lilly in the booming obesity-drug market. Self-pay obesity-drug prices are coming under broader pressure as Novo (NOVOb.CO) and Eli Lilly (LLY.N) turn to direct sales and telehealth firms to draw patients in, divert them from compounded copies and keep them on treatment for longer - even though deeper price cuts threaten margins. Read Full Article...

HVBA Article Summary

1. Discounted Subscription Strategy: Novo Nordisk is introducing a subscription plan for self-pay Wegovy patients in the U.S., with monthly prices discounted by up to nearly 30% compared to the standard rate. The plan is designed to make the medication more accessible to individuals who do not have insurance coverage for obesity drugs. Longer subscription commitments offer greater savings, aiming to encourage patient retention and adherence.

2. Competitive Market Dynamics: The move comes as competition intensifies between Novo Nordisk and Eli Lilly, both of which are targeting direct-to-consumer sales and leveraging telehealth platforms. Novo's price cuts are deeper than those of Lilly, reflecting a strategic effort to regain market share after lagging behind Lilly's Zepbound in prescription numbers. However, analysts and investors caution that aggressive discounting could impact Novo's profit margins in the ongoing price war.

3. Shift Toward Consumer-Focused Healthcare: The obesity drug market is evolving, with patients increasingly acting as healthcare consumers seeking transparent pricing and convenient purchasing options. Novo Nordisk is adapting by partnering with telehealth companies and moving outside traditional insurance channels, mirroring trends seen in other consumer industries. This shift is intended to attract and retain self-paying patients, especially as both companies work to steer users away from cheaper, compounded alternatives.

His brother's mental illness isolated his family. Now he's helping other caregivers

By Kat McGowan – For years, Mitul Desai felt that the best way to deal with his little brother's schizophrenia was to avoid talking about it. His brother had become angry and withdrawn during his first year in college in 1996, and then started hearing and seeing things that weren't there. Over four years doctors told the family he had everything from alcoholism to bipolar disorder, until finally he got the correct diagnosis. It was chaotic and frightening. There were also emergencies — major arguments, trips to the hospital, that time they had to convince the neighbors not to call the police. Read Full Article...

HVBA Article Summary

1. Family Caregivers Face Isolation and Stigma: Families supporting loved ones with serious mental illness often experience profound isolation and a lack of understanding from their communities. Unlike physical illnesses, mental health conditions are frequently met with silence or judgment, which can exacerbate the emotional burden on caregivers. This stigma can prevent families from seeking or receiving the support they need, making the caregiving journey even more challenging.

2. Support Systems for Caregivers Are Lacking but Evolving: Despite their crucial role, mental health caregivers historically have not received adequate resources or recognition. New initiatives, such as The CareHack and programs from organizations like NAMI and the Caregiver Action Network, are beginning to address these gaps by offering education, peer support, and crisis planning tools. These efforts aim to empower caregivers, reduce hospitalizations, and improve outcomes for both families and those with mental illness.

3. Caregiving for Mental Illness Is Uniquely Demanding: Caring for someone with a mental health disorder involves unpredictable crises, complex emotional dynamics, and the need for constant vigilance. Caregivers must often educate themselves and others about the illness, manage safety concerns, and cope with the risk of developing their own mental health issues. Recognizing and supporting caregivers not only benefits individuals with mental illness but also strengthens the broader health care system by preventing crises and reducing institutionalization.

4 ways GLP-1s are changing care patterns, patient behavior

By Ella Jeffries – Use of GLP-1 receptor agonists — including drugs such as Wegovy, Ozempic, Mounjaro and Zepbound — continues to reshape treatment patterns for obesity, diabetes and beyond. Several March studies and surveys highlight how these medications are shifting patient behavior, influencing surgical volumes, and raising new clinical and access considerations. Here are four notable GLP-1 developments: Surgery down, prescriptions up. Read Full Article...

HVBA Article Summary

1. Prescription Growth and Declining Bariatric Surgery Rates: A JAMA Surgery study found that GLP-1 prescriptions increased significantly from 0.22% in 2018 to 24.17% by the third quarter of 2025 among eligible adults. During the same period, bariatric surgery rates declined by 46.4%, falling from 0.17% to 0.09%. Data from nearly 32 million patient records in the Epic Cosmos database suggest a growing shift toward pharmacologic weight management.

2. Association With Reduced Substance Use Risks: A BMJ study examining more than 600,000 veterans found that GLP-1 use was associated with a lower risk of several substance use disorders, including alcohol, opioid, and nicotine use. The research also identified fewer overdoses, emergency department visits, and deaths among individuals with preexisting substance use disorders who were taking GLP-1 medications compared with those using other diabetes drugs. These findings indicate a potential broader impact of GLP-1 therapies beyond diabetes and weight management.

3. Cardiovascular Risks Linked to Treatment Discontinuation: A BMJ Medicine study involving 333,000 U.S. veterans with Type 2 diabetes reported that discontinuing GLP-1 medications was associated with increased cardiovascular risk. Individuals who stopped treatment experienced up to a 22% higher risk of heart attack, stroke, or death. Researchers noted that the cardiometabolic benefits of GLP-1 therapy appeared to decline rapidly after treatment interruptions, raising concerns given rising demand and medication shortages.