JPMorgan: How Small and Mid-Sized Businesses Make Healthcare Decisions

By Allison Bell - It’s no secret that small to mid-sized businesses are struggling to handle healthcare costs, and a report released last week from JPMorganChase Institute is adding to that evidence. The report found that roughly one-third of small businesses discontinued their health insurance coverage from one year to the next. Read Full Article…

HVBA Article Summary

1. Rising healthcare costs are prompting small businesses to drop coverage: Between 2018–2019 and 2022–2023, nearly a third of both employer and nonemployer firms discontinued paying health insurance premiums. Firms with the largest increases in insurance burden were the most likely to stop offering coverage.

2. Dropping insurance rarely means business closure: Most small businesses that ceased paying premiums continued operating—up to 70% of nonemployer and 79% of employer firms remained in business five years later, showing that discontinuing benefits is often a financial decision rather than a sign of instability.

3. Smaller firms face barriers to adopting alternative solutions: While options like ICHRAs are gaining traction, many small businesses lack the HR capacity to evaluate them. Confusion over fragmented benefits resources further hampers their ability to make informed healthcare decisions.

New Trump executive order may help knock out Biden-era mental parity regulations quickly

By Allison Bell - President Donald Trump has posted an executive order that could help the U.S. Labor Department overturn new mental health parity regulations quickly. The order directs federal agencies to skip the usual public comment period when repealing regulations that appear to be unconstitutional or appear to conflict with recent U.S. Supreme Court rulings, such as the Loper Bright Enterprises v. Raimondo ruling, which came out in June 2024. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Loper Bright ruling threatens NQTL regulations: The Supreme Court's Loper Bright decision curtails federal agencies’ authority to interpret statutes, raising questions about the legality of the Labor Department’s 2024 rule on non-quantitative treatment limits (NQTLs) under the Mental Health Parity and Addiction Equity Act (MHPAEA). Legal experts anticipate the rule could be a target for lawsuits, with critics arguing the rule exceeds MHPAEA’s original scope.

2. Compliance burdens and stakeholder pushback: The Biden-era NQTL rule introduced stringent network adequacy and parity requirements for mental health coverage, with estimated first-year compliance costs of $656 million. Employer groups, including the American Benefits Council, argue the regulations are impractical given the shortage of behavioral health providers and the complexity of implementing the standards.

3. Regulatory uncertainty under Trump administration: Although the Trump administration has not specifically addressed the NQTL rule, new executive orders aimed at reversing Biden-era health regulations could place the rule in jeopardy. Options include repealing the rule outright or replacing it with a more flexible version, but such rapid rollbacks may face legal challenges and create short-term uncertainty for employer health plans.

There is a Rebellion Against PBMs in State Capitals, Not Just in Washington

By Wendell Potter - Executives of pharmacy benefit managers (PBMs) have been dragged in front of Congressional committees for their role in inflating drug prices and undercutting local pharmacies, so it’s no wonder why headlines may make folks think that PBM reforms are only being considered in Washington, but that is far from the case. Read Full Article…

HVBA Article Summary

1. State-led PBM reform gains momentum amid federal inaction: As frustration with pharmacy benefit managers (PBMs) grows, states like Alabama, Arkansas, California, and North Carolina are advancing bipartisan reforms to protect independent pharmacies, improve transparency, and rein in practices like spread pricing. These efforts reflect broad public concern, especially as insured patients continue to struggle with high out-of-pocket drug costs.

2. Alabama and Arkansas lead with targeted, bipartisan legislation: Alabama passed two sweeping bills—SB252 and SB99—to ban below-cost reimbursements, eliminate gag clauses, and ensure fair dispensing fees for pharmacies. Arkansas, meanwhile, is challenging PBM-pharmacy ownership models through HB1150, aiming to eliminate conflicts of interest and safeguard pharmacy competition.

3. California and North Carolina focus on accountability and transparency: California’s SB41 would require PBM licensing and outlaw spread pricing, making violations criminal offenses. In North Carolina, HB163 targets unfair reimbursement and rebate practices while countering PBM lobbying efforts, with lawmakers emphasizing fairness and patient choice as core principles of reform.

Pfizer Stops Work on Oral GLP-1 Obesity Drug After Safety Signal Surfaces in Clinical Trial

By Frank Vinluan - Pfizer is playing catch-up in the crowded field of obesity medicines, but it hoped to compete with a daily pill alternative to currently available injectable GLP-1 products. Instead, Pfizer is stopping development of its drug, danuglipron, after a liver complication emerged in a clinical trial. Read Full Article…

HVBA Article Summary

1. Pfizer discontinues danuglipron after safety concerns: Pfizer halted development of its oral GLP-1 obesity drug danuglipron following a case of potential drug-induced liver injury and broader regulatory review. Although elevated liver enzymes were reportedly in line with approved GLP-1 drugs, any liver-related signals are seen as red flags in the competitive obesity market.

2. Shift in Pfizer’s obesity drug pipeline: This marks Pfizer’s second oral GLP-1 drug discontinued over liver enzyme concerns, following lotiglipron in 2023. Pfizer is now advancing other candidates—such as GIP-targeting PF-07976016 and GLP-1 agonist PF-0695-4522—but the company may increasingly look outside its own pipeline for viable metabolic drug options.

3. Viking’s VK2735 emerges as a potential partner or target: Analysts highlight Viking Therapeutics’ VK2735—an agonist of both GLP-1 and GIP receptors—as a promising candidate that could help Pfizer regain a leadership position in obesity treatments. Its strong early data, favorable safety profile, and dual formulation paths (oral and injectable) make it a standout in the field.

Employees and employers alike could gain from legal benefits

By Paola Peralta - The average benefit suite covers everything from paid time off to retirement. But what about when employees find themselves in legal trouble? Fifty-six percent of employees will face at least one legal matter during their career, according to a study from legal services company LegalShield. Yet, 26% of employees have no legal protection and 34% are relying on expensive pay-as-you-go legal services. Legal benefits have always been a voluntary benefit option, but it may be time for organizations to make them a permanent part of the rotation. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Legal benefits meet growing demand for personalized support: As employees seek more tailored benefit packages, legal services are emerging as a key component. LegalShield found that 57% of workers want will and estate planning services, while others prioritize family law (38%) and real estate support (26%), reflecting a shift toward benefits that align with various life stages and financial needs.

2. Legal issues can create financial and workplace strain: Without employer-provided legal benefits, employees often face significant out-of-pocket costs—78% of those who hired attorneys spent over $500. Legal matters also disrupt work: 61% of affected employees took time off, with 85% missing at least one full day, highlighting the broader impact on productivity.

3. Legal benefits enhance employee well-being and loyalty: Providing legal support contributes to a more engaged and satisfied workforce. The data shows 58% of employees report higher job satisfaction when legal benefits are offered, while 57% feel greater job loyalty—demonstrating how comprehensive benefit packages can reinforce employer commitment and workplace stability.

Federal government launches probe on drug imports: 5 notes 

By Erica Carbajal - The Department of Commerce has started an investigation into how pharmaceutical imports affect national security, according to a notice published April 14 in the Federal Register. The move is widely seen as a precursor to the U.S. imposing tariffs on pharmaceuticals, which President Donald Trump has been threatening for weeks. Read Full Article…

HVBA Article Summary

1. National security investigation launched into pharmaceutical imports: On April 1, the Commerce Department initiated a Section 232 investigation to assess whether imports of pharmaceuticals, ingredients, and derivative products pose a threat to national security. The public has 21 days to submit comments, and the department is required to deliver findings within 270 days—though officials suggest the process may wrap up sooner.

2. Trump signals new tariffs on drug imports: On April 8, President Trump announced that imported pharmaceuticals will soon face “major tariffs,” after being excluded from earlier rounds of reciprocal tariffs. This move builds on the current 10% universal tariff and reflects the administration’s push to reduce reliance on foreign drug supply chains.

3. Tariff concerns and domestic production challenges: Industry leaders and experts, while supportive of efforts to strengthen U.S. pharmaceutical manufacturing, caution that imposing tariffs could disrupt supply chains, cause shortages of generic medications, and increase costs. Despite recent billion-dollar U.S. expansion announcements from companies like Novartis, scaling domestic production could take several years.

Claritev’s Ceres^® Named “Data Solution of the Year for Insurance” in 2025 Data Breakthrough Awards Program

By Business Wire - Claritev Corporation (“Claritev” or the “Company”) (NYSE: CTEV), formerly known as MultiPlan, a technology, data and insights company focused on making healthcare more affordable, transparent and fair for all, today announced that one of its data and decision science solutions, Ceres®, has been selected as winner of the “Data Solution of the Year for Insurance” award in the 6th annual Data Breakthrough Awards’ Industry Applications Category. Read Full Announcement…

HVBA Article Summary

1. Ceres recognized for transforming benefit design with data and AI: Claritev’s Ceres platform earned a prestigious Data Breakthrough Award for its innovative use of artificial intelligence and decades of de-identified claims data from over a million members. The solution empowers benefits brokers and carriers to move beyond traditional, intuition-based decision-making toward a more strategic, high-value, data-driven approach to supplemental plan design.

2. Empowering precision and customization in supplemental insurance: Ceres allows users to model different census scenarios and predict benefit utilization and payout amounts with impressive accuracy. These insights enable strategic advisors to confidently recommend tailored product mixes that align with population-specific needs, helping organizations maximize value and impact in their supplemental offerings.

3. Industry validation from a leading data innovation awards program: Selected from thousands of global nominations, Ceres was honored by the 6th annual Data Breakthrough Awards for redefining supplemental insurance through cutting-edge data science. The award highlights Ceres’ role in helping carriers design and price plans more efficiently and accurately, setting a new standard for innovation in the benefits space.