DOL secretary resigns, new acting head has been active on benefits

By Allison Bell – Lori Chavez-DeRemer has resigned from her post as secretary of the U.S. Department of Labor, White House officials announced Monday. Chavez-DeRemer, who previously served in the U.S. House of Representatives, left the DOL post amid allegations that she had used office resources to pay for personal travel and other personal expenses. Keith Sonderling, the deputy Labor secretary, has taken over as the department's secretary. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Sonderling’s Leadership Approach and Enforcement Philosophy: Keith Sonderling has emphasized a shift within the Labor Department toward informal collaboration with employers rather than relying heavily on formal investigations or litigation. He has supported initiatives such as employer self-audits to encourage proactive compliance with labor laws. This approach reflects a broader preference for cooperative engagement and guidance over punitive enforcement measures.

2. Focus on Benefits Policy and Financial Regulations: Sonderling has backed efforts to expand flexibility in retirement planning, including easing restrictions on alternative assets in 401(k) plans. He has also promoted health care price transparency, regulation of pharmacy benefit managers, and policies aimed at protecting worker safety. These initiatives suggest an increased departmental focus on benefits, financial security, and access to information for workers.

3. Background, Policy Views, and Emerging Issues: Sonderling’s career includes roles in labor law, the Wage and Hour Division, and the Equal Employment Opportunity Commission, shaping his perspective on workplace regulation. He has supported classifying gig workers as independent contractors and has engaged in discussions on the role of artificial intelligence in employment decisions. His positions highlight ongoing debates around nontraditional work arrangements and the risks and opportunities associated with new technologies in the workplace.

The Top 15 Specialty Pharmacies of 2025: PBM-Affiliated Pharmacies Dominate While Health Systems and Independents Gain Ground

By Adam J. Fein, Ph.D. – Drug Channels Institute’s (DCI’s) latest analysis reveals that PBM-affiliated specialty pharmacies continue to dominate the dispensing of specialty drugs. For 2025, DCI has identified more than 1,900 dispensing locations with specialty pharmacy accreditation from one or both of the two major independent accreditation organizations. The overall number of accredited locations grew by only 3% in 2025, but is more than five times larger than the 2015 figure. However, market share for the dispensing of specialty drugs remains highly concentrated. For 2025, the three largest specialty pharmacies accounted for two-thirds of total prescription revenues from pharmacy-dispensed specialty drugs. Read Full Article...

HVBA Article Summary

1. Market Concentration and Vertical Integration: The specialty pharmacy sector remains dominated by a small number of PBM-affiliated companies, with the top three controlling two-thirds of prescription revenues. These leading pharmacies are part of vertically integrated organizations that also own pharmacy benefit managers, allowing them to exert significant control over specialty drug dispensing channels. This concentration is driven by strategies from both payers and manufacturers to narrow distribution networks.

2. Growth of Health System-Operated Pharmacies: Hospitals and health systems have rapidly increased their presence in the specialty pharmacy market, expanding from 106 accredited locations in 2017 to 553 in 2025. These entities now represent 28% of all accredited specialty pharmacies, and their growth is partly fueled by participation in the 340B Drug Pricing Program and changes in manufacturer policies. Health systems are increasingly steering prescriptions to their in-house specialty pharmacies, further shifting the market landscape.

3. Independent Pharmacies Face Challenges but Some Thrive: While independent specialty pharmacies remain the largest category by number of accredited locations, they account for a minority of total dispensing revenues. The most successful independents are larger, well-capitalized, and have attracted private equity investment, enabling them to grow quickly and secure spots in exclusive manufacturer networks. However, overall, the market is bifurcating, with scale and integration driving dominance at the top and selective access sustaining a smaller group of independent winners.

Medicare indefinitely delays pilot plan to cover weight loss drugs

By Max Bayer – The Centers for Medicare and Medicaid Services has delayed a key pilot program focused on Medicare coverage for obesity medications, after insurance plans indicated they wouldn’t participate at this time. Abe Sutton, head of the Center for Medicare and Medicaid Innovation, told Endpoints News in an interview Thursday that health plans were hesitant to join the pilot, citing instability in the Medicare Part D market and unknown utilization of the drugs. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. BALANCE Pilot Delayed as Government Extends Bridge Coverage: Federal officials postponed the rollout of the BALANCE pilot program after insurers requested additional time and data to evaluate participation. Instead, the government will continue funding a temporary bridge program covering obesity medications through 2027. No new implementation date has been announced, leaving the pilot’s timeline uncertain.

2. Eligibility Criteria Maintained with Focus on Access and Data Sharing: The bridge program will continue to cover patients based on BMI thresholds and related comorbidities, with no changes to eligibility requirements. Officials indicated that insurers did not raise concerns about the breadth of coverage and generally support expanding access to treatment. CMS will provide plans with data on patient drug utilization to inform future underwriting and participation decisions.

3. Insurer Hesitation and Market Impact Highlight Ongoing Challenges: Several major insurers, including UnitedHealthcareand Aetna, opted not to participate in the pilot due to structural and operational concerns. The BALANCE program is intended to enable Medicare and Medicaid coverage of obesity drugs despite existing statutory limits. Following insurers’ decisions, shares of Eli Lilly and Novo Nordisk declined, reflecting uncertainty around the program’s future impact.

Why more U.S. workers are hitting the panic button

By Bruce Shutan – Workplace safety is facing a critical reckoning, with an alarming rise in emergencies that highlight significant gaps in how well workers are protected, observes Kenny Kelley, CEO of Silent Beacon, which makes wearable panic buttons that alert emergency services, co-workers, supervisors and loved ones. "Nearly 70% of companies have reported a safety incident involving an employee working alone in the past three years, and one in five of these incidents were classified as quite or very severe," he says, noting a nearly 9% surge in U.S. workplace homicides was the highest levels in more than a decade. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Panic-Button Mandates Expand Workplace Safety Measures: Several states, including New York, New Jersey, Georgia, and Washington, have enacted panic-button requirements to strengthen emergency preparedness and response. These systems are designed to help workers in high-risk or isolated roles—such as healthcare staff, retail employees, and educators—quickly call for assistance. The goal is to reduce response time, which can significantly influence whether an incident escalates into a more serious crisis.

2. Workplace Violence Safety Alliance Drives Insurance Innovation: The National Workplace Violence Safety Alliance (NWVSA), founded by Lee Stokes, played a central role in developing a stand-alone workplace violence insurance product to address gaps in traditional coverage. This policy is designed to be affordable while offering benefits such as survivor payouts, income replacement, and medical support for affected employees. The initiative reflects NWVSA’s broader mission to expand access to meaningful protections and reduce the financial impact of workplace violence.

3. Limits of Security Measures Highlight Need for Broader Solutions: Increased spending on physical security, such as surveillance and access controls, has not fully prevented incidents of workplace violence. Experts note that such events are difficult to predict and nearly impossible to completely stop, underscoring the need for complementary strategies. Insurance coverage may also reduce the likelihood of lawsuits by providing compensation to victims’ families, while serving as a differentiator for organizations offering enhanced employee protections.

   
   This is part two of a series. Read part one here.

PLANSPONSOR Roadmap: Data-Driven Decisions—Let’s Talk Payment Integrity

By James Van Bramer – Executives and advisers in the health benefits sector described a system still shrouded in opacity, even after federal efforts to force transparency, during the second session of the 2026 PLANSPONSOR Roadmap: Health Benefit Fiduciary Duties livestream series. The speakers delivered a blunt warning to employers: Without greater access to data and the resolve to question vendors, companies risk wasting millions and increasing their exposure to legal liability. “Health care costs are continuing to rise at levels that are unsustainable,” said Jamie Greenleaf, moderator of the webinar and co-founder of Fiduciary In A Box. “So the government has really stepped in to provide us with additional transparency around cost and quality on our health care plans.” Read Full Article...

HVBA Article Summary

1. Persistent Data Transparency Challenges: Despite federal legislation such as the Consolidated Appropriations Act of 2021, employers continue to face significant obstacles in accessing the detailed health plan data needed to fulfill their fiduciary duties. Many employers mistakenly believe they have adequate data until they attempt to use it for claims evaluation or oversight. The lack of comprehensive data hampers their ability to monitor service providers and ensure reasonable fees.

2. Contractual and Administrative Barriers: The article highlights that problematic contract provisions and administrative practices often limit employers’ ability to oversee payment integrity. Some agreements allow vendors to retain savings from correcting their own errors or limit their liability, potentially violating fiduciary standards. Additionally, insurers and administrators may use claims of proprietary information, cybersecurity concerns, or high data access fees to restrict employer access to essential information.

3. Growing Employer Engagement and Recommendations: Rising health care costs and increased litigation risk are prompting more employers to take an active role in managing their health plans. Experts recommend that employers scrutinize contract language, demand detailed and usable data, and consider engaging independent analysts to identify inefficiencies and overspending. Starting with small steps, such as reviewing specific billing codes, can help employers gain better control over plan expenses and fiduciary risk.

DOJ seeks immediate asset freeze, receivership against telehealth company Zealthy

By Heather Landi – The Department of Justice filed a motion seeking an immediate asset freeze and receivership for telehealth company Zealthy and its CEO, Kyle Robertson, over alleged fraudulent prescribing and other deceptive practices, according to court documents. The DOJ filed an amended complaint last week against Zealthy and its CEO and founder, Kyle Robertson, the co-founder and former top executive at mental health startup Cerebral. Read Full Article...

HVBA Article Summary

1. DOJ Alleges Widespread Fraud and Deceptive Practices: The Department of Justice accuses Zealthy and its CEO, Kyle Robertson, of engaging in fraudulent prescribing and deceptive telehealth practices. The allegations include using unlicensed individuals to order prescriptions and misusing doctors' credentials without their knowledge. These practices are said to have affected tens of thousands of patients and prompted the DOJ to seek immediate intervention.

2. Asset Freeze and Receivership Sought Due to Ongoing Risks: The DOJ's motion for an asset freeze and receivership is based on concerns that Zealthy and its leadership are continuing to endanger patient safety and financial security. The government argues that only court-appointed oversight can halt the alleged lawbreaking and prevent further unauthorized charges and misuse of patient data. The potential penalties and consumer redress could be significant enough to bankrupt the company.

3. Pattern of Regulatory Issues Linked to Leadership: Kyle Robertson, previously the CEO of Cerebral, has faced similar regulatory scrutiny in the past, including settlements and fines related to unauthorized distribution of controlled substances and improper handling of patient data. Zealthy lost its LegitScript certification in 2025, further raising questions about its compliance with industry standards. The DOJ's actions reflect increasing regulatory attention on telehealth companies and their leaders' responsibilities.

How AI is fixing the benefit literacy gap

By Paola Peralta – AI is turning the traditionally complex, overwhelming process of selecting benefits into a more personalized and easy-to-understand experience. Eighty-five percent of employees say they feel confused about their benefits, according to a recent survey by Businessolver. However, when supported by AI, their assurance rises significantly: 79% of employees report feeling confident in their decisions, 85% rate their enrollment experience as great or excellent, and 77% say the process helped them understand their benefits very or extremely well. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. AI Enhances Personalization and Understanding: Artificial intelligence is being used to simplify the benefits selection process, making it more tailored to individual employee needs. By contextualizing large amounts of information and presenting it in a digestible format, AI helps employees better understand which benefits are most relevant to their unique situations. This approach reduces confusion and increases confidence among employees during enrollment.

2. Employee Demand for Anticipatory Guidance: Employees increasingly expect benefits platforms to not only list available options but also to provide guidance based on their specific life circumstances. AI can proactively suggest relevant benefits, such as accident insurance for those in high-risk activities or hospital indemnity for family planning, and can set reminders for important actions like submitting claims or managing flexible spending accounts. This anticipatory support helps ensure employees maximize the value of their benefits.

3. Adoption Gap Among Employers: Despite positive outcomes associated with AI-driven benefits platforms, a significant portion of executives are hesitant to update their technology. Survey data indicates that only about a third of leaders plan to evaluate their benefits technology in the next three years, while many remain uncertain about future plans. Experts suggest that timely adoption and ongoing analysis of employee needs are crucial for maximizing the effectiveness of benefits programs and leveraging AI’s full potential.

Alzheimer's Blood Tests: Most Patients Are Not Afraid to Know

By Judy George – Primary care patients educated about Alzheimer's disease blood-based biomarkers were generally willing to undergo tests and supported their use, survey data showed. After patients received a brief explanation of Alzheimer's blood tests, 94.5% supported offering them to patients with memory complaints, and 85% said they were willing to complete a test if their clinician recommended it, reported Andrea Russell, PhD, of Northwestern University Feinberg School of Medicine in Chicago, and co-authors. Read Full Article...

HVBA Article Summary

1. High Patient Willingness Despite Concerns: The majority of surveyed primary care patients expressed openness to Alzheimer's blood-based biomarker testing, especially when recommended by their clinician. Even though concerns such as cost, test reliability, and potential emotional distress were noted, these did not significantly deter most patients from considering testing. This suggests that while apprehensions exist, they are often outweighed by the perceived benefits of knowing one's Alzheimer's risk or status.

2. Importance of Education and Accessibility: Patients indicated that comprehensive education about the tests and their implications was a key factor in their willingness to undergo testing. Additionally, insurance coverage and the convenience of the testing process were important considerations for acceptance. These findings highlight the need for clinicians to provide clear information and ensure that logistical barriers are minimized to encourage broader adoption.

3. Evolving Role of Blood-Based Biomarkers in Diagnosis: Recent FDA clearances of blood-based diagnostic tests for Alzheimer's, along with evolving clinical guidelines, are expanding the use of these tools in both specialized and primary care settings. However, uncertainty remains regarding their diagnostic accuracy in more diverse primary care populations, and ongoing research is needed. The study also notes that patients who participate in research may be more receptive to testing than the general population, suggesting that broader public attitudes could differ.