Congress Scrutinizes Pharmacy Benefits Companies, Zeroing in on Alleged Kickbacks

By James Van Bramer – House lawmakers launched a bipartisan attack on pharmacy benefit managers during a hearing Wednesday, focusing on an allegation that some of the consultants hired by employers to help them choose drug-benefit managers are being paid by the very companies they are supposed to evaluate independently. During the hearing hosted by the House Education and Workforce Committee’s Subcommittee on Health, Employment, Labor and Pensions, lawmakers described PBMs—the companies that negotiate rebates, manage formularies and decide which pharmacies and drugs are favored in many insurance plans—as powerful intermediaries whose business practices have become too opaque for employers, workers and even regulators to follow. Read Full Article...

HVBA Article Summary

1. Concerns Over Conflicted Compensation: Lawmakers and witnesses raised concerns that some benefit consultants and brokers, who are supposed to help employers select the best pharmacy benefit managers (PBMs), may be receiving payments from the PBMs themselves. This arrangement could create conflicts of interest, incentivizing consultants to recommend PBMs based on compensation rather than the best interests of employers and plan participants. Such practices have the potential to undermine trust in the procurement process and may lead to higher drug costs for employers and employees.

2. Regulatory and Legislative Responses: The hearing highlighted recent efforts by Congress and federal agencies to increase oversight of PBMs. Legislative proposals, such as the PBM Kickback Prohibition Act, aim to ban PBMs from paying brokers or consultants to steer business their way. Additionally, new rules from the Department of Labor and provisions in the Consolidated Appropriations Act of 2026 require greater transparency, mandating PBMs to disclose compensation arrangements and pass through rebates to employer health plans.

3. Bipartisan Agreement and Ongoing Debate: There is rare bipartisan consensus that PBMs act as powerful intermediaries whose incentives may not align with those of employers or patients. However, some lawmakers and experts argue that while reforming PBM practices is important, it will not fully address the broader issue of high drug prices set by manufacturers. The hearing underscored the complexity of the drug pricing system and the need for comprehensive solutions that address all players in the supply chain.

Minnesota’s 340B Hospitals Make One Billion More From 340B Than They Spend on Uncompensated Care

By Bryce Platt, PharmD – Minnesota’s new 340B data reveal a growing disconnect between the program’s size and the value Minnesotans receive in return. In 2024, nonprofit hospitals generated more than $1.3 billion in 340B net profits—nearly a billion dollars more than they provided in uncompensated care. At the same time, these same institutions already benefit from substantial tax exemptions tied to their not-for-profit status and charitable mission. The gap between 340B profits and charity care isn’t a rounding error or a one-off anomaly. The 340B Drug Pricing Program has evolved into a significant profit center for hospital systems. This is another layer on top of existing public subsidies, not a substitute for them. Read Full Article...

HVBA Article Summary

1. Hospitals Capture the Vast Majority of 340B Profits: The Minnesota Department of Health’s report shows that hospitals account for 93% of 340B purchases and absorb 98% of the program’s net profits in the state. Federal grantees, which have explicit drug affordability mandates, receive only a small fraction of these profits and often struggle to break even. This concentration of financial benefit among hospitals suggests the program has shifted from its original safety-net focus to a broader profit-generating mechanism for large health systems.

2. 340B Profits Far Exceed Uncompensated Care and Tax Benefits: In 2024, nonprofit hospitals in Minnesota made nearly a billion dollars more in 340B net profits than they spent on uncompensated care, in addition to receiving substantial tax exemptions. This raises questions about whether the financial gains from the 340B program are being used to support community benefit obligations or simply boosting hospital margins. The lack of clear benchmarks or requirements for how these profits are spent makes it difficult to assess the program’s effectiveness in serving vulnerable populations.

3. Transparency and Accountability Remain Limited: Despite the detailed financial data provided by Minnesota’s reporting, there is still no requirement for hospitals to disclose how 340B profits are used. Most of the revenue comes from commercial and Medicare plans, which may ultimately lead to higher premiums for payers and patients. Policymakers and the public are left without answers as to whether these funds are supporting charity care, infrastructure, or other uses, highlighting a need for greater oversight and transparency in the program.

FTC files suit over telemarketing scheme selling fake PPO insurance

By Paige Minemyer – The Federal Trade Commission has filed suit to intervene in a scheme in which it says fraudulent telemarketers targeted individuals seeking insurance coverage. Per the complaint (PDF), which was filed earlier this month, the FTC alleges that participants in the scheme—who operated under names like American Collective and Innovative Partners—would contact consumers and tell them that they must pay to renew or maintain their health plans. The agency said that targeted consumers paid millions in "premiums" for health coverage that they didn't actually need or want, while failing to provide coverage that could address their medical costs. The complaint alleges that the fraudulent behavior dates back to at least early 2023. Read Full Article...

HVBA Article Summary

1. FTC Targets Alleged Insurance Fraud: The Federal Trade Commission has taken legal action against a group accused of running a telemarketing scheme that sold fake PPO insurance plans. The alleged fraudsters reportedly misrepresented themselves as legitimate insurers or government agencies, pressuring consumers to pay for unnecessary or nonexistent coverage. This action highlights the FTC's ongoing efforts to protect consumers from deceptive practices in the health insurance market.

2. Scheme Involved Misleading Claims and Inadequate Coverage: According to the complaint, the telemarketers promised comprehensive, state-issued PPO plans with no deductibles or coinsurance, but actually sold products that offered only limited discounts and capped payments for certain services. Many essential services, such as hospital care, were excluded from these plans, leaving consumers without real protection when seeking medical treatment. The misleading nature of these offers resulted in consumers paying significant sums for inadequate or unwanted coverage.

3. Broader Regulatory Context and Enforcement Priorities: The FTC's lawsuit follows the recent launch of its Healthcare Task Force, which aims to identify and address new enforcement priorities in the healthcare sector. The Commission emphasized that combating unlawful conduct that increases healthcare costs and undermines system integrity is a top priority. This case serves as an example of the agency's commitment to holding companies accountable for practices that harm consumers and distort the healthcare marketplace.

The ‘groundbreaking’ case of the cyber experts who allegedly broke bad and worked with criminals

By Sean Lyngaas – US companies in the retail, hospitality and medical sectors trusted Angelo Martino to negotiate with hackers who were trying to extort them. Instead, he made the extortion worse, federal prosecutors allege. Martino allegedly accumulated at least $10 million in assets, including a luxury fishing boat and two properties, as he worked as a ransomware negotiator — one of the most sensitive jobs in cybersecurity. He also gave a major cybercriminal gang information about his clients’ negotiating positions in order to “maximize” the ransom payments and then take his own cut of them, according to federal prosecutors. Read Full Article...

HVBA Article Summary

1. Groundbreaking Case Raises Industry Oversight Questions: A recent Justice Department case is described as “groundbreaking” because it highlights ethical concerns within the cybersecurity industry, particularly regarding firms involved in ransomware response. Officials note that while many providers operate professionally, the case underscores the possibility of misconduct among some actors. The situation is prompting broader reflection on accountability and oversight in a rapidly growing sector.

2. Insider Misconduct Undermines Trust in Cybersecurity Services: The case involves cybersecurity professionals accused of participating in ransomware attacks and sharing in illicit payments, despite being trained to prevent such crimes. Their actions demonstrate how insider threats can compromise the integrity of organizations tasked with protecting victims. The incident illustrates the risks associated with conflicts of interest and lack of transparency in ransom negotiations.

3. Industry and Government Reassess Practices and Safeguards: In response to the case, government agencies and cybersecurity firms are evaluating measures to reduce insider threats and improve ethical standards. Officials are considering forums such as roundtables to strengthen collaboration and establish clearer guidelines. Some companies have already updated policies, including removing financial incentives tied to ransom payments, to ensure more objective and transparent support for victims.

A comprehensive checklist to boost caregiving support for employees

By Kim Thiboldeaux – Former First Lady and passionate family caregiver advocate Rosalynn Carter famously said: "There are only four kinds of people in the world: Those who have been caregivers, those who are currently caregivers, those who will be caregivers and those who will need caregivers." I had the privilege of collaborating with Mrs. Carter and The Rosalynn Carter Institute for Caregivers located in Americus, Georgia on caregiving initiatives that addressed helping employees manage the burdens and embrace the unexpected joys of caregiving. All employers, from small businesses to the largest companies, can play a critical role in helping employees cope with the burdens of caregiving, and I urge employers to reframe caregiving as a workplace issue rather than a personal responsibility. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Caregiving Is a Universal Workplace Issue: The article emphasizes that caregiving affects nearly everyone at some point, either directly or indirectly. Employers are encouraged to recognize caregiving as a workplace concern rather than solely a personal matter. By reframing the issue, organizations can better support employees and foster a more inclusive and understanding work environment.

2. Significant Economic and Emotional Impact: Recent studies cited in the article highlight the immense economic value of unpaid caregiving, with estimates reaching hundreds of billions of dollars annually. Caregiving responsibilities often equate to a part-time or full-time job for employees, leading to increased stress and potential negative effects on work performance. Employers who acknowledge these challenges can help mitigate employee burnout and improve retention.

3. Actionable Steps for Employers: The article provides a checklist of practical actions employers can take to support caregiving employees, many of which require little or no additional cost. Suggestions include educating managers, offering flexible work arrangements, providing access to reliable resources, and creating a culture where caregiving is openly discussed. Implementing these measures can enhance employee well-being and contribute to a more supportive workplace culture.

Semaglutide prescriptions jump 50%: 5 notes

By Ella Jeffries – More Wegovy prescriptions are being written as GLP-1 weight loss drugs gain traction across retail, telehealth and direct-to-consumer channels, according to an April 20 report from Truveta Research. The growth follows the FDA’s December approval of oral Wegovy (semaglutide) and other GLP-1 pills. Diverging commercialization strategies from manufacturers are also reshaping how patients access these therapies and how health systems approach formularies and metabolic care programs. Here are five things to know from the report: Read Full Article...

HVBA Article Summary

1. Significant Increase in Semaglutide Prescriptions: The report highlights a more than 50% rise in first-time semaglutide prescriptions for anti-obesity use from December 2025 to March 2026. This marks the largest quarter-over-quarter increase since mid-2024, indicating a surge in demand for this medication. The trend suggests growing acceptance and utilization of GLP-1 drugs for weight management.

2. Expansion of Access Channels and New Formulations: The introduction of oral GLP-1 drugs, such as oral Wegovy, and their availability through retail, telehealth, and direct-to-consumer platforms have contributed to the increased uptake. Manufacturers are employing different commercialization strategies, which are changing how patients obtain these medications. This expansion is also influencing how health systems manage formularies and metabolic care programs.

3. Broader Impact on Prescription Volume and Patient Reach: Between January 2019 and March 2026, over 2.8 million patients received a GLP-1 receptor agonist, resulting in nearly 14.7 million prescriptions. The steady growth in both first-time and overall GLP-1 prescribing reflects a broader shift in obesity treatment patterns. These trends may have implications for healthcare delivery, patient outcomes, and the future landscape of metabolic care.

Life insurance for gig economy power earners: what advisors need to know

By Anna Baluch – The U.S. gig economy is made up of roughly 57 million workers, according to the latest data from Deloitte. By 2027, the global accounting firm predicts freelancers and gig workers will become most of the workforce. Insurance advisors would do well to recognize the growing presence of this demographic and meet the unique needs and goals of clients who are currently involved in the gig economy or plan to join it in the near future. “Well-designed life insurance policies and properly guided strategies can become very desirable to those with high incomes, income fluctuations, and workers who want more tax-free growth and more tax-efficient planning for capital needs earlier in life,” explained Josh Anderson, president and CEO of Eagle Legacy & Financial. Read Full Article...

HVBA Article Summary

1. Growing Gig Economy Demographic: The gig economy is rapidly expanding, with projections indicating that freelancers and gig workers will soon make up the majority of the workforce. This shift underscores the importance for insurance advisors to understand and address the unique financial planning needs of this group. As more individuals transition to gig work, traditional employment benefits like life insurance are often unavailable, increasing the need for tailored solutions.

2. Unique Life Insurance Needs for Gig Workers: Gig economy power earners typically do not receive employer-sponsored life insurance, making individual policies essential for their financial security. These workers often experience fluctuating incomes, which can complicate long-term planning and the ability to maintain consistent coverage. Advisors must consider flexible policy options and strategies that accommodate income variability and provide both protection and potential financial growth.

3. Flexible Policy Solutions and Strategies: Products such as term laddering, universal life, and policies with flexible premium options can be particularly beneficial for gig workers. These solutions allow policyholders to adjust coverage and payments in response to changing income levels, and may offer features like cash value accumulation or riders for liquidity needs. By leveraging these flexible strategies, advisors can help gig workers safeguard their families and adapt to the unpredictable nature of gig economy earnings.