Trump signs executive action to lower drug prices

By Sydney Lupkin - President Trump signed an executive action Tuesday intended to lower prescription drug prices for Americans. A White House official, speaking on condition of anonymity, told reporters ahead of the signing that the move would include "delivering lower prices to seniors" and improve the Medicare drug price negotiation program, which was created by the Inflation Reduction Act that passed in 2022. Read Full Article…

HVBA Article Summary

1. Expanded Medicare Drug Price Negotiation and Importation Initiatives: The administration plans to build on Biden-era savings by expanding Medicare drug price negotiations—targeting 15 additional drugs in 2025—and reviving low-cost programs for insulin and epinephrine. It also directs the FDA to expedite state drug importation programs and streamline the approval of generics and biosimilars to lower costs.

2. Delayed Consumer Impact and Potential Tariff Risks: Although the initiatives aim to reduce prices, consumers won’t see savings until at least 2026–2027. Meanwhile, a federal investigation into pharmaceutical imports may lead to tariffs, which could drive up costs for many medications despite ongoing cost-saving efforts.

3. Addressing Pricing Imbalances Between Pills and Biologics: The executive action highlights a disparity in Medicare’s negotiation timelines—7 years for pills versus 11 for biologics—leading to investment skewed toward expensive injectable drugs. The administration seeks legislative collaboration to fix this imbalance without increasing Medicare spending, while also aligning Medicare drug payments with hospital acquisition costs across care settings.

The death of traditional benefits: Why employees need personalization

By Brian Harrison - Employee benefits have long been a standard part of the workplace, but today’s workforce expects more than just a basic package of health insurance, a 401(k), and paid time off. With nearly half of American workers (48.4%) having been with their current employer for less than a year, the traditional model of benefits designed for long-term retention is breaking down. Employees don’t just want benefits — they want benefits that are curated to their specific needs, easily accessible, and seamlessly integrated into their financial and personal lives. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Choice without clarity leads to decision paralysis: Expanding benefit options—from mental health support to pet insurance—has created an overwhelming environment for employees, who are often left without personalized guidance to make confident decisions. Despite good intentions, too many options without clear navigation result in confusion and underutilization.

2. Personalization and integration are the future of benefits: Traditional, siloed benefits models are giving way to integrated “one wallet” strategies that help employees make better financial decisions. Modern platforms should actively guide individuals on where to allocate their next dollar based on their life stage and financial goals, making the benefits experience more relevant and impactful.

3. Employers must simplify and modernize the benefits experience: Leading companies are adopting AI-powered decision tools, bundling holistic benefit packages, and embracing flexible, lifestyle-focused perks. By shifting from passive administration to active support, employers can transform benefits into a strategic asset for employee engagement, retention, and financial wellness.

9 prior authorization updates 

By Andrew Cass - From UnitedHealthcare planning to cut prior authorization by 10% in 2025 to a congressman reintroducing reform legislation on, here are nine prior authorization updates that Becker’s has reported on since March 3. Read Full Article…

HVBA Article Summary

1. Federal and state efforts target prior authorization reform: Lawmakers across multiple states — including Tennessee, California, Hawaii, and North Carolina — are pushing legislation to increase transparency, set timelines, and regulate the use of AI in prior authorization processes, while CMS declined to finalize federal guardrails around AI use in its latest Medicare rule.

2. Insurers and PBMs begin scaling back requirements: UnitedHealthcare plans to reduce prior authorization requirements by 10% in 2025, and Optum Rx is removing prior authorization for about 80 drugs, reflecting a broader industry shift to improve access and reduce administrative burdens for patients with chronic conditions.

3. New research and automation challenge status quo: A study presented at the AAOS 2025 conference found that prior authorization can increase costs for certain procedures like hip replacements, while health systems like MUSC Health are now automating prior authorizations with AI, completing 40% of them without human input.

Medication Adherence and Deprescribing Programs Aren’t Enough for Today’s Polypharmacy Patients

By Adva Tzuk Onn - As the Boomer generation ages, the prevalence of polypharmacy — patients taking multiple medications to manage chronic conditions — is surging. Nearly 40% of older adults take five or more medications, a number that has tripled in the last two decades. Read Full Article…

HVBA Article Summary

1. Deprescribing alone is not enough — polypharmacy requires a broader, patient-centered strategy: While deprescribing is important, especially with studies showing that many older adults may be taking unnecessary medications, it can be harmful if done in isolation. Health systems must consider how medications interact as part of a patient’s total health picture, rather than focusing solely on cost or adherence. Poorly planned deprescribing can backfire, worsening symptoms and increasing reliance on other medications.

2. Holistic medication optimization is key to success in value-based care (VBC): Traditional approaches that emphasize adherence or drug interactions miss critical health risks and cost drivers. In VBC models, providers are financially accountable for outcomes, so a comprehensive medication strategy must evaluate effectiveness, appropriateness, and long-term risks across the entire regimen. This includes regularly reassessing treatments in the context of a patient’s broader health goals and using technology to scale this process across large populations.

3. Redefining medication management as a tool for whole-person health: To truly improve patient outcomes, providers must view medications not as isolated prescriptions but as dynamic components of care that should evolve with a patient's needs. Elevating medication use to a clinical strategy — not just a compliance task — allows providers to avoid preventable harm, reduce costs, and deliver higher-quality, more personalized care.

The Top 15 Specialty Pharmacies of 2024: How PBMs, Health Systems, and Independents Are Shaping the Market

By Drug Channels - Drug Channels Institute’s (DCI’s) latest analysis reveals that PBM-affiliated specialty pharmacies continue to dominate the dispensing of specialty drugs. DCI has identified nearly 1,900 dispensing locations with specialty pharmacy accreditation. Below, we share DCI’s latest analysis of the top 15 specialty pharmacies, including updated market shares and revenue estimates. Read Full Article…

HVBA Article Summary

1. Market Concentration and PBM Dominance: In 2024, two-thirds of all prescription revenues from pharmacy-dispensed specialty drugs were generated by pharmacies affiliated with the three largest PBMs—underscoring how tightly specialty dispensing is linked to vertically integrated PBM organizations. These entities increasingly rely on specialty drug dispensing as a major profit center, using opaque mechanisms like 340B margins, manufacturer fees, and copay maximizer partnerships.

2. Growth of Provider and Health System Dispensing: Hospitals and health systems now operate 27% of accredited specialty pharmacies—up from 15% in 2017—as they respond to evolving manufacturer policies and seek financial advantages through in-house operations and the 340B program. Meanwhile, more physician offices are engaging in specialty dispensing, particularly for oral oncology drugs.

3. Market Pressures on Independent Pharmacies: Independent specialty pharmacies, while numerous, continue to lose revenue share amid consolidation and competitive pressures from PBM-owned and health system-affiliated pharmacies. Despite headwinds, some independents still play key roles in exclusive manufacturer networks, especially as biosimilars, generics, and non-specialty therapies shift the specialty revenue landscape.

Standing Issues Cripple PBM Case in the District of Minnesota

By Emily Payson - We have been watching cases alleging that fiduciaries are mismanaging prescription drug benefit programs at Your ERISA Watch for several years now. These lawsuits contend that plan sponsors and fiduciaries of ERISA-governed healthcare plans are breaching their fiduciary duties by contracting with middlemen called pharmacy benefit managers (“PBMs”), with little oversight, in a way that harms plan participants. Read Full Article…

HVBA Article Summary

1. Allegations of Mismanagement and Conflict of Interest: Former Wells Fargo employees allege that the company breached its fiduciary duties under ERISA by mismanaging its prescription drug benefits plan. They claim Express Scripts, the plan’s PBM, charged excessive administrative fees and significantly inflated drug prices—sometimes over 2,000% higher than retail prices—due to a contract requiring participants to use its own specialty pharmacy, Accredo.

2. Court Finds Plaintiffs Lack Standing: Although the court acknowledged that high premiums and out-of-pocket costs could, in theory, constitute injury, it dismissed the case for lack of Article III standing. The court concluded that plaintiffs’ alleged harm was too speculative and not clearly traceable to the fees or drug markups, especially since Wells Fargo retained discretion over contribution rates and could raise them regardless of any recovery.

3. Potential Implications for Future PBM Litigation: While sympathetic to concerns about rising drug costs and PBM practices, the court emphasized that legal claims must meet constitutional standing requirements. The dismissal, though without prejudice, highlights significant legal hurdles plaintiffs may face in future ERISA lawsuits aimed at challenging PBM arrangements and fiduciary oversight.

MassMutual Collaborates With Benefit Harbor for Streamlined Access to Group Whole Life Insurance

By Business Wire - MassMutual has selected Benefit Harbor to join its suite of enrollment technology platforms supporting voluntary employee benefits. Benefit Harbor provides holistic enrollment and benefits administration in one platform for their customers. This collaboration brings a streamlined, user-friendly solution for offering group whole life insurance. Read Full Announcement…

HVBA Article Summary

1. Streamlined Integration with Workday: MassMutual’s partnership with Benefit Harbor includes a Workday Certified API that enables real-time, enterprise-level integration of group whole life insurance into Workday cases. This seamless connectivity simplifies benefits enrollment, enhances the employee experience, and reduces friction for HR teams and benefits brokers.

2. All-in-One Benefits Administration: Benefit Harbor’s platform serves as a single-source solution for enrollment and benefits administration, ensuring accurate and secure data transmission. Built-in compliance features and automation help companies reduce administrative workload, improve efficiency, and deliver a more seamless experience for employees managing their group life insurance.

3. Customized Solutions for Clients: MassMutual now has direct access to configure and customize the Benefit Harbor platform for individual client needs. This tailored approach allows for optimized plan designs and user interfaces, giving employers and brokers a flexible, scalable way to meet diverse workforce expectations and drive engagement with voluntary benefits.