EBSA Lays Out Enforcement Priorities Ahead of Aronowitz Hearing in the House

By James Van Bramer – The Employee Benefits Security Administration announced its enforcement priorities late Tuesday, emphasizing the Department of Labor’s recent priority shifts to focusing primarily on severe cases of misconduct. The notice comes before Daniel Aronowitz, assistant secretary of labor and head of EBSA, is set to testify Thursday before the House Committee on Education and the Workforce’s Subcommittee on Health, Employment, Labor and Pensions. It will be his first appearance in Congress since he was confirmed to the post in September. Read Full Article...

HVBA Article Summary

1. EBSA’s Enforcement Focus: The Employee Benefits Security Administration (EBSA) is shifting its enforcement strategy to prioritize the most egregious cases of misconduct that result in significant harm to plan participants. This approach is intended to ensure that resources are directed toward addressing the most serious breaches, particularly those involving violations of the fiduciary duty of loyalty under ERISA. Less emphasis will be placed on technical breaches of fiduciary prudence unless they are accompanied by loyalty violations.

2. Commitment to Fairness and Transparency: EBSA has stated it will avoid “regulation by enforcement” and instead provide clear guidance to plan sponsors and fiduciaries. The agency aims to increase transparency and consistency in its actions, including requiring senior leadership reviews of major enforcement initiatives and ensuring that enforcement decisions are communicated in advance. These measures are designed to foster a fair regulatory environment and uphold the rule of law.

3. Timeliness and Oversight Improvements: To improve efficiency, EBSA has set specific timelines for completing investigations, with routine cases expected to conclude within 18 months and more complex cases within 30 months, barring exceptional circumstances. Senior officials, including Assistant Secretary Daniel Aronowitz, will receive regular updates on ongoing investigations that exceed these timeframes. This focus on timeliness and oversight is intended to enhance accountability and ensure prompt resolution of enforcement matters.

Proposed House bill would mandate free heart disease risk testing

By Allison Bell – A new House bill could require employers' health plans to expand coverage for tests for two heart disease risk factors, lipoprotein(a) and apolipoprotein B. Self-insured employer plans, fully insured group health insurance plans, Medicare plans and Medicaid plans would all have to provide "free" Lp(a) and ApoB testing, without imposing deductible requirements, copayment requirements or other cost-sharing requirements on the patients. Rep. Sheila Cherfilus-McCormick, D-Fla., the bill sponsor, said Tuesday in a bill introduction announcement that improving coverage for Lpa(a) and ApoB tests could save lives, because they are key indicators of heart disease and may not show up on standard cholesterol tests. "By eliminating cost barriers to advanced cardiovascular testing, we can improve health outcomes, reduce disparities and save lives," Cherfilus-McCormick said. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Bill Expands Access to Advanced Heart Disease Testing: The proposed legislation would require a broad range of health plans, including employer-sponsored, Medicare, and Medicaid, to cover lipoprotein(a) and apolipoprotein B tests at no cost to patients. These tests are considered more precise indicators of heart disease risk than standard cholesterol tests. By removing financial barriers, the bill aims to facilitate early detection and intervention for individuals at high risk.

2. Current Treatment Landscape for Heart Disease Risk Factors: While patients with high apolipoprotein B levels can often manage their condition with statins and certain other medications, there are currently no FDA-approved treatments for elevated lipoprotein(a) levels. Several pharmaceutical companies, such as Novartis, Eli Lilly, and Amgen, are actively developing drugs targeting high Lp(a), but these treatments are still in the testing phase. The lack of approved therapies highlights the importance of risk identification and monitoring through testing.

3. Potential Impact on Health Disparities and Outcomes: The bill's sponsor emphasizes that eliminating cost-sharing for advanced cardiovascular tests could help reduce health disparities and improve outcomes, particularly for populations that may not have access to comprehensive screening. By mandating coverage without deductibles or copays, the legislation seeks to ensure that financial constraints do not prevent high-risk individuals from receiving potentially life-saving diagnostics. This approach aligns with broader efforts to address inequities in preventive health care.

House eyes bill to allow drug expenditures to count toward insurance deductibles

By Mariah Taylor – Rep. Greg Murphy, MD, R-N.C., has introduced a bill that would require out-of-pocket expenditures for drugs to count toward a patient’s maximum out-of-pocket and deductible. Patients are increasingly getting prescription medications through direct-to-patient platforms that offer lower out-of-pocket costs, especially for high-cost, brand-name drugs, according to an April 14 news release. However, many health plans do not count this spending toward the patients’ deductible unless the drug is purchased on a plan-designated channel. This framework requires patients to “pay twice,” and can result in delayed care and access. Read Full Article...

HVBA Article Summary

1. Legislative Proposal to Address Out-of-Pocket Costs: The bill introduced by Rep. Greg Murphy seeks to ensure that all out-of-pocket spending on prescription drugs, regardless of where the medication is purchased, counts toward a patient's insurance deductible and maximum out-of-pocket limit. This change would address a gap in current insurance practices that often exclude spending on drugs bought outside plan-designated channels. The proposal aims to reduce the financial burden on patients who use direct-to-patient platforms for their prescriptions.

2. Impact on Patient Access and Financial Burden: Under current insurance frameworks, patients who purchase medications through non-designated channels may end up paying twice—once for the medication and again toward their deductible. This can lead to delayed care and reduced access to necessary medications, particularly for those relying on high-cost, brand-name drugs. The bill is intended to eliminate this double payment scenario and improve timely access to treatments.

3. Potential to Increase Competition and Lower Drug Prices: Supporters of the bill argue that allowing out-of-pocket expenditures from direct-to-patient platforms to count toward insurance requirements could foster greater competition in the drug marketplace. By making it easier for patients to benefit from lower-cost options, the legislation could help drive down overall drug prices. The bill is positioned as a patient-first approach that encourages innovation and affordability in prescription drug access.

Rising tide of workplace violence takes its toll

By Bruce Shutan – At a time when indiscriminate violence permeates American life, it has become a mind-numbing staple that often leads the nation's 24/7 news cycle. Acts of fury inevitably spill into the workplace where more than 2 million victims, including 5,000 fatalities, cost businesses $300 billion. "We've become this incredibly intolerant nation," laments Lee Stokes, founder of CSA Insure and the National Workplace Violence Safety Alliance (NWVSA), which has sought to help close an important insurance gap in the face of this troubling trend. "We feel like it's okay to do people bodily harm if something doesn't go our way. And so right now, we know that no industry is immune to workplace violence." Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Coverage Gaps in Traditional Insurance: Standard workers' compensation and life insurance policies often exclude incidents of workplace violence, especially when the violence is deemed personal or involves unconventional weapons. This leaves many victims and their families without financial support after traumatic events. Specialized workplace violence insurance policies are being developed to address these gaps and provide more comprehensive protection.

2. High-Risk Industries and Financial Impact: Healthcare, education, and fast-food industries are particularly vulnerable to workplace violence, with healthcare alone incurring $18 billion in related costs last year. The prevalence of violence in these sectors is contributing to workforce shortages, such as the ongoing nursing shortage, and is driving up the cost of services. Employers in other sectors, like property management, are also experiencing a rise in violent incidents affecting their staff.

3. Expanded Benefits and Support for Victims: New workplace violence insurance offerings include survivor benefits, income replacement, rehabilitation, and mental health support for victims and their families. These policies have evolved to address the real needs of those affected, such as adding coma benefits due to the frequency of severe head injuries. The majority of victims require some form of rehabilitation or counseling, highlighting the importance of comprehensive post-incident care.

Large employers demand accountability as health care prices surge

By Alan Goforth – Affordability remains the overwhelming concern for large employers as prices continue on an upward trajectory with no meaningful rationale. Other areas of consistent focus from the country's top employers are the need for enhanced transparency and more sophisticated data analytics tools, signaling their intent to more closely scrutinize newly available information to effectively address price increases. "These priorities, coupled with the growing frustrations our members are expressing, should be a wake-up call for many health care stakeholders who think the status quo is acceptable and that the days of blank checks will never end," said Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health (PBGH). Read Full Article...

HVBA Article Summary

1. Affordability and Premium Increases Remain Central Concerns: Large employers are increasingly worried about the rising costs of health care, with premiums expected to grow by 6% to 7% in 2026 and some individual market plans seeing increases of over 20%. These increases are outpacing inflation and are not matched by clear improvements in quality or value. The persistent rise in costs is prompting employers to seek new strategies to manage expenses and ensure value for their employees.

2. Demand for Transparency and Data-Driven Decision Making: Employers are prioritizing access to transparent pricing and quality data to better evaluate the fairness of health care costs. The variability in pricing for similar procedures across providers and regions, often unrelated to quality, has led employers to adopt more sophisticated analytics tools. This shift enables them to pursue strategies such as bundled payments, direct contracts, and centers of excellence to optimize spending.

3. Reform and Innovation in Pharmacy and Primary Care: With the passage of the Consolidated Appropriations Act in 2026, reforming pharmacy benefit management is a top priority for both policymakers and purchasers. More than a quarter of surveyed employers are already using nontraditional pharmacy benefit managers to address opaque practices and rising drug costs. Additionally, there is a strong focus on advanced primary care models that integrate preventive and behavioral health, aiming to improve outcomes and patient experience while controlling costs.

5 updates on GLP-1 drugs: Pricing, access, FDA scrutiny

By Ella Jeffries – Use of GLP-1 receptor agonists continues to shift rapidly, with early April developments highlighting changes in pricing models, drug access, regulatory oversight and personalized care. Here are five notable GLP-1 developments: Novo Nordisk launched a multimonth subscription program for Wegovy, with prices ranging from $329 per month for three months to $249 per month for a 12-month plan, offering up to $1,200 in annual savings for self-pay patients. The model is designed to reduce cost variability and improve adherence, a persistent challenge for GLP-1 therapies. The company also introduced a higher-dose Wegovy HD, a 7.2-milligram injection priced at $399 per month, expanding dosing options beyond the previous 2.4-milligram maximum. Read Full Article...

HVBA Article Summary

1. Evolving Pricing and Access Strategies: Pharmaceutical companies are introducing new subscription models and higher-dose options to make GLP-1 drugs more affordable and accessible for self-pay patients. These changes aim to address cost variability and improve patient adherence, which has historically been a challenge for these therapies. The expansion of oral GLP-1 options and partnerships with major pharmacies like Amazon are further broadening access.

2. Increased Regulatory Oversight and Safety Measures: The FDA is tightening its oversight of compounded GLP-1 products, emphasizing that compounding is only permitted during branded drug shortages. Pharmacies and manufacturers have received warnings about producing or marketing unapproved versions, and the agency is actively monitoring misleading claims in the market. This regulatory focus is intended to ensure patient safety and maintain the integrity of the drug supply.

3. Personalized and Next-Generation Therapies on the Horizon: Research is revealing genetic factors that may influence both the effectiveness and side effects of GLP-1 drugs, suggesting a future where prescribing could be tailored to individual patients. Drugmakers are also developing next-generation therapies with longer dosing intervals and new use cases, such as maintenance therapy or treatment for more severe obesity. These innovations indicate a shift toward more personalized and long-term obesity care.

Benefits leaders report increased operational, financial costs amid 'digital health vendor sprawl': Solera survey

By Cailey Gleeson – For many employers, digital health vendor management is creating both operational and administrative costs that potentially rival the savings that these programs are meant to provide, according to a new report. Solera Health surveyed 106 U.S.-based senior benefits leaders in mid-, large and major enterprises across various sectors, including healthcare. Forty-two percent of surveyed employers in the April 2026 report say they manage eight or more digital health vendors, and 90% report spending more than $1 million annually on costs. “Employers are spending six figures just to manage the vendors that were supposed to save them money,” said Glenn Alphen, Solera Health chief commercial officer, in a statement. Read Full Article...

HVBA Article Summary

1. Escalating Costs and Complexity: The survey reveals that managing multiple digital health vendors is leading to significant operational and financial burdens for employers. Many organizations are dedicating substantial resources, including full-time staff and external consultants, to handle the growing complexity. These costs can offset or even surpass the intended savings from implementing digital health solutions.

2. Operational Strain and Resource Allocation: A majority of benefits teams are now spending considerable time each week on vendor management, with some organizations requiring two or more dedicated employees for this task. The need for additional support is widespread, as evidenced by the high percentage of employers turning to outside consultants and third-party administrators. Despite these efforts, many still face frequent issues that require intervention, indicating persistent operational challenges.

3. Impact on Broader Initiatives and Strategic Concerns: The administrative burden of managing numerous vendors is not only causing delays in the implementation of digital health initiatives but is also affecting multiple projects simultaneously. This situation is contributing to team fatigue and diminishing executive confidence in digital health strategies. The report suggests that without streamlined integration and clearer implementation processes, vendor sprawl may hinder innovation and become a strategic liability for organizations.

The Fascinating Phenomenon That Is Your Brain on Exercise

By Caitlin Carlson – Common knowledge: Exercise is good for you. A little less common, but still pretty common: Exercise is good for your brain. Not very common knowledge but should be: The cascade of beneficial effects in the brain when we exercise is remarkable — and understanding that might make people want those benefits. That last bit is the important part, considering how difficult it is to ignite and maintain motivation in people (maybe even you) to exercise regularly. Read Full Article...

HVBA Article Summary

1. Exercise Significantly Impacts Brain Structure and Function: Research demonstrates that regular physical activity, especially aerobic and resistance exercise, can increase brain volume and improve the integrity of both gray and white matter. These changes are linked to enhanced cognitive abilities and may help counteract age-related brain shrinkage, particularly in regions like the hippocampus. The improvements are not observed with low-intensity activities, highlighting the importance of exercise intensity.

2. Physical Activity Enhances Brain Networks and Chemical Pathways: Exercise strengthens the connectivity of key brain networks involved in executive function, memory, and emotional regulation. It also influences the production of important brain chemicals such as brain derived neurotrophic factor (BDNF) and insulin-like growth factor (IGF), which are associated with neuroprotection and cognitive health. While the exact mechanisms are still being studied, these effects may contribute to reduced risk of cognitive decline and mental health disorders.

3. Optimal Exercise Recommendations for Brain Health: Experts suggest that a minimum of 150 minutes per week of moderate-intensity aerobic exercise, along with at least two days of muscle-strengthening activities, is likely beneficial for both cognitive and mood outcomes. Higher intensity and greater muscle strength gains appear to yield more pronounced brain benefits, though the best type and dose of exercise may vary by individual and health status. Practices like Tai Chi may also offer cognitive advantages, but more rigorous research is needed to clarify their effects.