PBM pharmacy ownership ban passes in Tennessee

By Allison Bell – Members of the Tennessee House voted 86-7 Tuesday for final state General Assembly passage of a bill that could prohibit pharmacy benefit managers from owning or controlling pharmacies. The bill now heads to the desk of Tennessee Gov. Bill Lee, who is a Republican. Drafters of the Freedom, Access and Integrity in Registered Pharmacy Act bill, or FAIR Rx Act bill, have included a section stating that the bill simply regulates ownership of Tennessee pharmacies, not insurance coverage or employer health plans governed by the Employee Retirement Income Security Act. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Tennessee Legislature Passes PBM Ownership Ban: The Tennessee General Assembly has approved the FAIR Rx Act, which would prevent pharmacy benefit managers (PBMs) from owning or controlling pharmacies in the state. The bill is now awaiting the governor's signature. This legislation aims to address concerns about potential conflicts of interest and market consolidation within the pharmacy sector.

2. Legal Challenges Expected Due to ERISA Preemption: Despite the bill's language stating it does not regulate employer health plans governed by ERISA, recent federal court rulings have found that similar state laws are preempted by ERISA. The 6th U.S. Circuit Court of Appeals recently upheld decisions blocking Tennessee laws that attempted to regulate PBMs serving ERISA plans. If enacted, the FAIR Rx Act is likely to prompt further legal disputes over the extent of state authority to regulate PBMs in the context of federal law.

3. Stakeholder Reactions and Broader Implications: Major PBMs and their parent companies, such as CVS Health, have strongly opposed the legislation, warning of potential pharmacy closures and legal action. Proponents argue the bill would benefit independent pharmacies and increase transparency, while critics claim it could reduce patient access and fail to lower drug costs. The ongoing debate reflects broader national tensions over PBM practices, state regulatory efforts, and the boundaries set by federal benefits law.

UnitedHealth Q1 '26 Earnings: Wall Street is in Love Again

By Wendell Potter – UnitedHealth Group’s stock is surging today – up almost 9% by noon to north of $350 a share — after the nation’s largest health insurer reported first-quarter 2026 adjusted earnings of $7.23 per share, easily beating the Wall Street consensus of $6.57. Investors loved that and also the fact that the company raised its full-year 2026 adjusted earnings guidance to greater than $18.25 per share, up $0.50 from its prior target. So Wall Street got what it wanted. The question worth asking is what it cost — and who paid. Read Full Article...

HVBA Article Summary

1. Profit Growth Driven by Membership Losses: UnitedHealth’s strong earnings and improved medical loss ratio were achieved in part by shedding a significant number of Medicare Advantage and Medicaid members, particularly those who are older, sicker, or lower-income. This strategy reduced the company’s medical costs as a percentage of premiums, which pleased investors but left over a million people seeking new coverage. The company’s approach reflects a deliberate trade-off between margin recovery and membership growth, prioritizing profitability over expanding or maintaining coverage for vulnerable populations.

2. Increased Reliance on Automation and AI: UnitedHealth is investing heavily in automation and artificial intelligence, with $1.5 billion allocated to these technologies. The company is rolling out AI-driven tools for prior authorization, claims processing, and member services, aiming to reduce manual work and operating costs. While these changes promise efficiency and faster decisions, they also raise concerns about reduced human oversight and the potential for automated denials or errors that may go unchallenged by patients.

3. Business Model and Regulatory Scrutiny: A growing portion of UnitedHealth’s revenue involves internal transactions between its insurance and provider divisions, a practice known as intercompany eliminations, which has increased by 256% over the past decade. This self-dealing model, where the company pays its own subsidiaries more than independent providers, has drawn attention from lawmakers and regulators. Ongoing investigations and bipartisan questions highlight concerns about the scale and integration of UnitedHealth’s operations, as well as the broader implications for competition and patient care.

Phishing — sometimes with AI’s help — topped initial-access methods in Q1, Cisco says

By Eric Geller – Cisco described a credential-harvesting scheme in which attackers used the Softr AI platform to build a website that mimicked the Outlook Web Access login page. Cisco said this was “the first time we have documented the use of a specific AI tool by an adversary in a phishing campaign.” The company said it was fairly confident that attackers have been using Softr for credential-harvesting websites since May 2023 “and have done so with increasing frequency to date.” Read Full Article...

HVBA Article Summary

1. Phishing Reemerges as Leading Attack Vector: Phishing was the most common method used by attackers to gain initial access in the first quarter of 2026, returning to the top spot after nearly a year. Attackers are increasingly using AI tools to enhance phishing campaigns, improving efficiency and scale. This development lowers the technical barrier, enabling less sophisticated actors to carry out effective credential-harvesting attacks.

2. Ransomware Activity Declines but Remains Relevant: Nearly 20% of incident-response engagements involved the early stages of ransomware attacks, a notable decrease from roughly 50% in early 2025. Despite the decline, ransomware continues to play a role in broader cyberattack strategies. The trend suggests attackers may be prioritizing initial access techniques, such as phishing, before deploying ransomware payloads.

3. Targeted Sectors and Security Weaknesses Identified: Government and healthcare organizations were the most frequently targeted sectors, likely due to sensitive data and operational vulnerabilities. Weak or misconfigured multifactor authentication was the most common security issue, contributing to 35% of incidents. Additional risks included vulnerable internet-facing systems and insufficient logging capabilities, which further enabled successful intrusions.

Retailers race into GLP-1 market as costs, care models shift

By Ella Jeffries – Amazon and Walmart have launched GLP-1 weight management programs within days of each other, signaling a broader shift as retailers, payers and drugmakers compete to control access to one of healthcare’s fastest-growing drug classes. Amazon’s One Medical program integrates primary care, pharmacy and virtual services into a single platform, while Walmart has expanded weight management support across its nearly 4,600 locations. Both models are designed to manage patients over time — including prescribing, monitoring and follow-up — functions traditionally handled within health system primary care and specialty clinics. The push comes as demand accelerates across the market. Read Full Article...

HVBA Article Summary

1. Retail Expansion and Integrated Care Models: Major retailers like Amazon and Walmart are entering the GLP-1 weight management market, offering integrated care that combines primary care, pharmacy, and virtual services. This approach allows for comprehensive patient management, including prescribing, monitoring, and follow-up, which were previously managed by traditional healthcare providers. The involvement of large retailers is likely to increase accessibility and convenience for patients seeking obesity treatment.

2. Financial and Systemic Impacts: The rapid growth in GLP-1 prescriptions is contributing to significant financial pressures for health systems and insurers. For example, increased spending on these drugs has been linked to substantial losses for some insurance divisions, prompting tighter coverage requirements and policy changes. Additionally, federal agencies are reevaluating payment models for these therapies, reflecting ongoing concerns about long-term affordability and sustainability.

3. Changing Landscape for Hospitals and Patient Care: As GLP-1 use rises, hospitals are seeing a decline in bariatric surgery volumes, indicating a shift in how obesity is being treated. Early research suggests potential benefits of GLP-1 drugs in reducing mortality from certain obesity-related cancers, though evidence is still preliminary. Health systems must now adapt to a landscape where obesity care is increasingly delivered outside traditional clinical settings, requiring new strategies for competition and collaboration.

Elevance perks up in 2026 though Medicare Advantage payout could ding profits

By Rebecca Pifer Parduhn – Elevance on Wednesday became the second major insurer to raise its 2026 earnings guidance on the back of better-than-expected first quarter results — though, a massive potential payout over faulty data reporting in Medicare Advantage could cut into Elevance’s bottom line this year. The Indianapolis-based payer raised its annual adjusted diluted earnings per share guidance from at least $25.50 to at least $26.75. Investors had expected a raise, but not of this magnitude, echoing UnitedHealth’s unexpectedly robust beat-and-raise on Tuesday. Read Full Article...

HVBA Article Summary

1. Profit Outlook Raised Amid Regulatory Uncertainty: Elevance increased its 2026 adjusted earnings guidance following a strong first quarter, surprising investors with the size of the raise. However, the company’s unadjusted earnings outlook was reduced due to the potential financial impact of a Medicare Advantage data reporting issue. The insurer faces a possible payout to the Centers for Medicare & Medicaid Services (CMS) that could range from $350 million to $1.5 billion, reflecting significant uncertainty around the final liability.

2. Operational Adjustments and Margin Improvements: Despite challenges in government programs like Medicare Advantage (MA) and Medicaid, Elevance has taken steps to improve margins, such as exiting unprofitable markets and focusing on cost control. These actions have led to a reduction in MA membership but are helping the company approach its margin targets for the program. The company’s overall membership grew due to gains in commercial and Affordable Care Act (ACA) plans, offsetting losses in MA and Medicaid.

3. Sector Trends and Regulatory Developments: The broader health insurance sector has seen improved investor sentiment as medical costs appear more manageable in early 2026. Recent regulatory decisions, including a finalized 2.5% rate increase for MA in 2027, have provided some relief to insurers, though executives remain cautious about future benefit expansions. Elevance’s experience highlights ongoing pressures from government reimbursement rates and the importance of regulatory compliance for financial performance.

How employers end up paying for weight gain

By Wei-Li Shao – Employers are spending more on GLP-1s than ever before, and I believe many of them are actually paying for weight gain. GLP-1s have kicked employer healthcare spending into overdrive, with many reporting that covering GLP-1s had a "significant" impact on the health plan's prescription drug spending. Some are willing to pay the price, betting that treating obesity now avoids the higher costs of managing diabetes, hypertension and musculoskeletal conditions down the line. The logic is reasonable, but the reality is more complicated. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. GLP-1 Spending and Abandonment Rates: Employers are investing heavily in GLP-1 medications with the expectation of reducing long-term health costs associated with obesity-related conditions. However, a significant portion of patients discontinue these medications within a year, undermining the potential health and financial benefits. This high abandonment rate means that much of the spending does not translate into sustained health improvements for employees.

2. Importance of Lifestyle and Clinical Support: Research indicates that combining GLP-1 medications with structured lifestyle interventions, such as nutrition counseling and behavioral coaching, leads to better health outcomes. Without these supports, employees are more likely to lose muscle mass, regain weight after stopping the medication, and experience poor overall results. Employers who do not integrate clinical and lifestyle support into their GLP-1 coverage risk wasting resources and failing to achieve desired workforce health improvements.

3. Risks of Unregulated Access and Employer Responsibility: As cash-pay and direct-to-consumer options for GLP-1s expand, employees may access non-FDA-approved or inadequately supervised medications. This trend increases safety risks and reduces employer oversight of health outcomes. Employers are encouraged to guide their workforce toward regulated, clinically supervised treatment pathways and to design benefits that prioritize both access and safety.

Employers Can ‘Bend or Lose’ on Flexible Work Arrangements

By Emily Boyle – Employers, beware: Offering flexibility may be essential to keep pace with the future of benefits and the changing workforce. “It’s always been ‘employer first,’” says Marcia Mantell, president of Mantell Retirement Consulting Inc. “The employer [sets] the lay of the land and the rules of the road, and you play by them or you leave.” Mantell says that since the COVID-19 pandemic, in contrast, that mentality has turned upside down. In response to employee demands for hybrid, remote and other flexible work, “employers have largely had to bend or lose,” she says. Read Full Article...

HVBA Article Summary

1. Flexible Work Becomes Standard Practice: Employers are increasingly offering hybrid and remote work arrangements, with 80% providing hybrid schedules and 53% offering fully remote options. Additional flexible formats, such as flextime (62%), part-time roles (43%), and compressed workweeks (25%), are also common. These trends indicate a long-term shift in workplace structure that is unlikely to return to pre-pandemic norms.

2. Family-Oriented Benefits Influence Employee Decisions: Benefits such as parental leave, healthcare, and flexible work arrangements are significant factors in employee retention, particularly among Millennials who often have caregiving responsibilities. Survey data shows many employees would consider leaving their jobs if these benefits are reduced. At the same time, some major companies have begun scaling back such benefits, reflecting a disconnect between employee expectations and employer policies.

3. Tailored Benefits Drive Loyalty Across Generations: Employers are increasingly recognizing the need to align benefits with a multigenerational workforce. Younger employees tend to prioritize family-related benefits, while older workers value retirement-focused offerings such as 401(k) contributions and phased retirement options. Providing targeted benefits, including caregiving support and gradual retirement pathways, can improve employee loyalty and help organizations retain institutional knowledge.

Direct contracting is no longer a concept (Expo preview)

By Lester Morales – Health care transformation rarely starts with policy. It starts locally, with people willing to challenge the status quo and take action where they are. That's exactly what's happening today with Direct Contracting. While much of the industry continues to debate solutions, a growing number of advisors have moved beyond theory and into execution, building care delivery models in real markets with real employers and providers. These aren't pilot programs. They're active models delivering care in communities right now. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Direct Contracting Moves from Theory to Practice: The article highlights that direct contracting in health care is no longer just a conceptual idea but is being actively implemented in various markets. Advisors are working directly with employers and providers to create operational care delivery models that are already serving communities. This shift demonstrates a tangible move toward alternative health care arrangements outside of traditional insurance models.

2. Advisors’ Roles Are Evolving: As direct contracting gains traction, the responsibilities of benefits advisors are expanding beyond traditional plan evaluation and negotiation. Advisors are now acting as builders and strategists, facilitating partnerships between employers and providers and helping to design new systems. This evolution requires them to address operational challenges and foster trust among all stakeholders involved.

3. Applicability Across Employer Sizes: The article notes that direct contracting is not limited to large employers; it is being adapted for groups of various sizes. By pooling employers together, advisors are able to create the necessary scale for sustainable provider partnerships, making the model accessible to a broader range of organizations. This inclusivity is helping to drive broader adoption and momentum for direct contracting in the health benefits space.