PBMs Are Duping Business Owners and Crushing Workers

By Luke Sullivan - The fastest-growing cost for most large to medium business owners this year won’t be due to tariffs. It will be providing prescription drug benefits for their employees. And evidence suggests those plan sponsors don’t know what to do about it or even why it’s happening. Business owners expect to pay nearly 8% more this year to provide health insurance for their employees. That’s the highest increase in nearly 15 years, according to a survey of large business owners by the Business Group on Health. Read Full Article…

HVBA Article Summary

1. Insurance Premiums Are Rising Sharply for Workers and Families: Individual employee premiums rose from $7,739 in 2021 to $8,951 in 2024, while family coverage premiums climbed from $22,221 to $25,572 over the same period. The study attributes much of this increase to rising pharmacy costs, driven by inflation in drug prices, the widespread use of GLP-1 medications, and employers’ limited awareness of how their drug benefits are structured and managed.

2. PBMs Create a Complex and Opaque Health Care System: Pharmacy benefit managers (PBMs) — mainly CVS Caremark, Optum Rx, and Express Scripts — control close to 80% of U.S. drug spending. These PBMs negotiate drug prices, decide which medications are covered, and manage how drugs are dispensed, often without fully disclosing pricing structures to employers. This lack of transparency enables PBMs to favor their own financial interests while leaving businesses and employees with unpredictable and often higher costs.

3. Employers and Employees Face Increasing Financial Pressure: As insurers continue steering employers toward high-deductible health plans, a growing number of American workers are struggling with out-of-pocket medical expenses. Meanwhile, most employers, lacking in-depth healthcare knowledge and relying heavily on brokers or consultants, find themselves unable to challenge PBM-dominated systems. This dynamic exacerbates financial hardship for the sickest employees and contributes to the disappearance of local pharmacies, leading to pharmacy deserts in many communities.

Obamacare Is Killing Small Business. Here's How To Fix It.

By Sally Pipes - Obamacare was back on trial this month, as the U.S. Supreme Court heard a challenge about the constitutionality of the panel that determines which preventive care services health plans must cover. According to the Commonwealth Fund, “The case has consequences for the Affordable Care Act’s guarantee of coverage for a wide range of free preventive care.” Read Full Article…

HVBA Article Summary

1. Rising health insurance costs are forcing small businesses to drop coverage: A JPMorganChase Institute study found that one-third of businesses with fewer than 50 employees drop health insurance annually, mainly due to rising premiums. Sectors like restaurants, repair services, and construction have seen particularly high rates of dropped coverage, which threatens small business stability and broader economic growth.

2. Expanding access to Association Health Plans and short-term insurance could offer relief: Association Health Plans (AHPs) allow small businesses and independent workers to band together and access more affordable, less-regulated coverage. Similarly, short-term, limited-duration plans, which were expanded under Trump and restricted under Biden, offer lower-cost insurance options exempt from many Obamacare mandates.

3. Calls for regulatory rollback to restore affordable options: The article argues that reinstating Trump-era rules on AHPs and short-term insurance could help offset the burden of costly ACA-compliant plans, providing small businesses and workers with more affordable health insurance choices and supporting entrepreneurship and economic growth.

Student loan debt is stressful. Benefit managers have the power to help

By Lee Hafner - Student loans can be a major source of financial strain, and when employees are anxious about money, their minds are somewhere other than work. How can benefit managers turn this into an opportunity to attract, retain and offer relief to talent? Maggie Ruvoldt, CHRO at LEARN Behavioral, an autism support organization, and Will Sealy, founder and CEO of student loan and education assistance platform Summer, discussed this topic at EBN's Financial Wellness Virtual Summit April 23. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Student Loan Debt is a Growing Financial Wellness Concern: LEARN recognized that resumed student loan payments are now a major stressor across all workforce generations, impacting financial stability and long-term goals like homeownership. With 43.5% of Gen Z, 40% of millennials, and significant portions of Gen X and baby boomers carrying student debt, the organization saw student loan support as essential to modern employee financial wellness — beyond traditional retirement offerings.

2. Providing Student Loan Assistance Improves Employee Focus and Talent Retention: By offering Summer's student loan solutions, LEARN enabled employees to access loan forgiveness programs, restructured repayment options, and financial counseling. This not only alleviates employee financial stress but also strengthens workplace focus, particularly critical for LEARN’s specialists and educators. Ruvoldt emphasized that helping employees manage student debt is crucial for attracting and retaining top talent in a competitive market.

3. Student Loan Benefits Deliver Tangible ROI for Employers: Summer’s analytics show a 20% reduction in employee turnover and a 35% higher adoption rate compared to other voluntary benefits, with employees saving an average of $40,000. LEARN views this offering as a high-impact, low-effort solution that directly improves employee loyalty, performance, and financial outcomes, making it a smart investment for both employee wellbeing and organizational success.

💡Brokers, join us May 14th in Houston for HVBA’s Benefits Roadshow. You'll hear from Summer and other innovative solutions. Register today!

When Hospitals Ditch Medicare Advantage Plans, Thousands of Members Get To Leave, Too

By Susan Jaffe - For several years, Fred Neary had been seeing five doctors at the Baylor Scott & White Health system, whose 52 hospitals serve central and northern Texas, including Neary’s home in Dallas. But in October, his Humana Medicare Advantage plan — an alternative to government-run Medicare — warned that Baylor and the insurer were fighting over a new contract. If they couldn’t reach an agreement, he’d have to find new doctors or new health insurance. Read Full Article…

HVBA Article Summary

1. Medicare Advantage Plan Breakups Are Increasing and Disrupting Access to Care: Disputes between health systems and Medicare Advantage insurers are becoming much more common, with separations tripling over the past two years. At least 41 hospital systems have exited 62 Advantage plans across 25 states since July, often forcing seniors to either scramble for new doctors or stay in plans with shrunken provider networks. While the Centers for Medicare & Medicaid Services (CMS) sometimes grants special enrollment periods, many members remain stuck without easy options.

2. Special Enrollment Periods Help Some but Are Inconsistent and Poorly Communicated: CMS has allowed limited groups of Medicare Advantage members to switch plans or move to traditional Medicare after losing key providers, but the agency does not consistently notify all affected individuals or disclose which plans have triggered these protections. Insurers also continue enrolling new members without revealing that their networks have shrunk, leaving many seniors unaware of their rights or trapped in narrower provider options for the remainder of the year.

3. Calls Grow for Stronger Protections and Guaranteed Medigap Access: Lawmakers, insurance commissioners, and advocates warn that the current system leaves too many seniors vulnerable to disrupted care and higher out-of-pocket costs. They are pressing CMS to automatically grant special enrollment periods whenever major provider groups leave a plan and to ensure guaranteed access to Medigap supplemental coverage. Without these changes, many Medicare Advantage members risk being locked into reduced networks or facing steep financial barriers to returning to traditional Medicare.

How HR should handle workplace harassment, violence from customers

By Caroline Colvin - HR often sorts out relationship dynamics between co-workers, but what about external harassment? Business leaders should know that they can be legally liable for harassment and discrimination born from clients, vendors and customers. Read Full Article…

HVBA Article Summary

1. Customer-Driven Discrimination and Hostile Conduct Are Leading to Major Legal and Reputational Risks: Companies like SmartTalent, Buffalo Wild Wings, and Costco have faced lawsuits and financial penalties for complying with customer requests based on discrimination or failing to protect employees from harassment by customers. Experts stress that customer-facing harassment—whether from inappropriate boundary violations or overt discrimination—can severely harm employee mental health and business operations.

2. Employers Are Shifting from Police Intervention to De-escalation Strategies: Following high-profile incidents involving inappropriate law enforcement responses, many companies are emphasizing de-escalation training for frontline workers to manage disruptive or hostile customers. Experts recommend equipping employees with techniques to calmly handle escalating situations, reducing the likelihood of litigation, reputational damage, or physical violence.

3. Formal Policies and Training Are Essential to Address Serious and Violent Threats: Security professionals stress the need for comprehensive workplace violence protocols, periodic training, and crisis simulations. From emotionally damaging harassment to physically dangerous threats, organizations must proactively prepare employees and HR teams to handle severe incidents safely—emphasizing internal response systems before involving external authorities.

💡Brokers, join us May 14th in Houston and hear from the National Workplace Violence Safety Alliance and help businesses prepare for and respond to workplace violence incidents, minimizing disruptions. Secure your spot!

Novo Nordisk Notches a Court Win Against Wegovy and Ozempic Compounders

By Frank Vinluan - Compounded versions of Novo Nordisk’s Wegovy and Ozempic will need to stop production soon. Lawsuits over these products are ongoing, but a federal court ruling in Texas means that compounding pharmacies can’t keep making their products as the legal process continues. The April 24 order by U.S. District Court Judge Mark Pittman was sealed. Read Full Article…

HVBA Article Summary

1. Court upholds FDA shortage resolution, ending compounding allowances: The federal court upheld the FDA’s determination that shortages of semaglutide (the main ingredient in Wegovy and Ozempic) have been resolved. As a result, traditional compounding pharmacies (503A) must immediately stop making compounded versions, and 503B outsourcing facilities must cease production by May 22, after which FDA enforcement actions may occur.

2. Compounders' legal challenge rejected despite claims of ongoing shortages: The Outsourcing Facilities Association, representing 503B facilities, sued to challenge the FDA’s decision, arguing that shortages persist. However, the court declined to consider new evidence presented after the case was filed, siding with the FDA's assessment based on growing supplies from manufacturers like Novo Nordisk and Eli Lilly.

3. Manufacturers strengthen supply and launch direct-to-patient options: To meet demand and compete with compounders, Novo Nordisk and Eli Lilly have invested heavily in expanding production and introduced direct-to-patient pharmacy platforms (NovoCare and LillyDirect), offering lower-cost options for obesity and metabolic treatments, further stabilizing market supply.

Healthcare remains top target for cybercriminals with an uptick in hacking attacks in 2024

By Heather Landi - The healthcare sector continues to be a prime target for cyberattacks with an increase in incidents and breaches in 2024. System intrusion, which includes ransomware, is now the top cause of healthcare data breaches, according to Verizon's 2025 Data Breach Investigations Report (DBIR). Ransomware attacks across all industries rose by 37% and are now present in 44% of breaches, despite a noticeable decrease in the median ransom amount paid, the report found. Read Full Article…

HVBA Article Summary

1. Healthcare faces escalating cyber threats and breach impacts: The healthcare sector experienced 1,710 security incidents and 1,542 confirmed data breaches between November 2023 and October 2024, a sharp rise from the previous year. Ransomware continues to disproportionately impact healthcare and small businesses, with major breaches like Change Healthcare’s cyberattack affecting nearly 190 million individuals.

2. Third-party and espionage threats are rising significantly: Verizon’s 2025 DBIR highlights that third-party breaches now account for 30% of incidents, severely impacting healthcare providers through vulnerabilities in partners like radiology and IT firms. Meanwhile, espionage-motivated attacks surged in healthcare from 1% to 16%, signaling the emergence of stealthier, state-affiliated threat actors targeting the sector.

3. Data breaches are driving severe legal and financial consequences: Healthcare organizations faced the highest proportion of class-action lawsuits (32.7%) related to data breaches, contributing to over $154 million in settlements between August 2024 and February 2025. The most common violations included inadequate cybersecurity practices, failure to encrypt sensitive data, and delayed breach notifications, intensifying financial liabilities.