77% of healthcare orgs targeted by ransomware in past year

By Jill McKeon - More than three-quarters of healthcare survey respondents said their organizations were targeted by ransomware in the past 12 months, and 53% of those attacks were successful, highlighting the ongoing challenge of combatting healthcare cyberattacks. Read Full Article…

HVBA Article Summary

1. Ransomware Trends and Impact in Healthcare: A global survey of 1,500 IT and security professionals found a decline in reported ransomware attacks compared to the previous year, yet ransom payments remain common, with 55% of all respondents paying multiple times. In healthcare, 40% of respondents experienced one attack, 42% two attacks, and 12% simultaneous incidents, with 35% facing new attacks within one to six days. These attacks often compromised identity infrastructure and caused data breaches, brand damage, and job losses.

2. Comparative Sector Payment Rates and Financial Impact: Healthcare organizations reported lower ransom payment rates than other sectors—53% compared to 75% in IT/telecom, 77% in finance, and 57% in government. Most healthcare payments were $500,000 or less, though 39% ranged between $500,000 and $1 million. Globally, paying ransoms did not always ensure recovery, with 15% of victims receiving corrupted or missing decryption keys, or having stolen data published despite payment.

3. Expert Recommendations and Call for Cyber Resilience: Industry experts stressed that paying ransoms should not be the default, warning that it fuels the criminal economy and incentivizes repeat attacks. The report recommends investing in cyber resilience, preparing for evolving ransomware tactics, documenting and testing incident response, and strengthening partner and supply chain security to reduce the likelihood and impact of future incidents.

Could this HRSA Pilot Program Signal Future Changes to the 340B Program?

By Luke Gale - HRSA has dipped its toes into the debate over the 340B Drug Pricing Program, announcing it that it will test a rebate model through a voluntary pilot program. The announcement comes shortly after the federal government scored a legal win against drug companies that attempted to unilaterally implement a rebate model. Read Full Article…

HVBA Article Summary

1. Background and Scrutiny of the 340B Program: The federal 340B drug pricing program, created to help hospitals and clinics serving vulnerable populations obtain medications at reduced prices, is under intensified scrutiny. Drug manufacturers have accused hospitals of violating program requirements, while the American Hospital Association argues that HRSA data shows drug companies are more likely to breach rules and face fewer audits. This ongoing tension has prompted calls from lawmakers for stronger oversight, with competing narratives on where the primary compliance issues lie.

2. Legal Dispute Over Discount vs. Rebate Models: A major point of contention has been whether the 340B program should continue offering upfront discounts or move toward a rebate-based system. Several large drug manufacturers, including Johnson & Johnson, Eli Lilly, and Novartis, attempted to unilaterally implement rebate models, but HRSA denied these changes. In a significant legal decision, a federal court affirmed HRSA’s authority to approve or reject such models, siding against Johnson & Johnson and reinforcing the agency’s role in maintaining the program’s traditional structure.

3. HRSA Pilot Program and Hospital Concerns: HRSA has launched a voluntary pilot to test a rebate-based payment model for a limited set of sickle cell medications, with the stated aim of ensuring access to critical treatments. Under this system, hospitals would pay negotiated higher prices upfront and later apply for manufacturer rebates through a third-party administrator. Hospital advocacy groups warn that this approach could create significant cash flow challenges and administrative complexity, with 340B Health estimating that disproportionate share hospitals could need to front an average of $72 million to drug companies while waiting for reimbursement.

Employers shifting to self-insurance will still face soaring costs, Voya says

By Allison Bell - Voya has bad news for employers with fully insured health plans that want to avoid big cost increases by shifting to self-insured plans: Rates for stop-loss insurance will also go up. A lot. Stop-loss insurance can protect sponsors of self-insured plans against catastrophic losses. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Voya’s Strategy in the Stop-Loss Market: Voya executives emphasized that the company is responding to persistently elevated medical claim costs, which began rising sharply about a year ago, by embedding these higher costs into its stop-loss pricing structure. The company is maintaining a disciplined approach, focusing on strengthening profit margins rather than simply chasing premium growth.

2. Market Outlook: Voya anticipates opportunities to expand its customer base, particularly among smaller employers who are increasingly considering self-insurance as a strategy to manage the escalating cost of traditional health insurance. This trend could contribute to broader growth in the stop-loss market despite current cost pressures.

3. Industry Context: The surge in medical claim costs seen since mid-2024 is affecting the entire industry, driving insurers to raise premiums. Preliminary small-group rate filings in several states suggest that fully insured health coverage could see significant increases in 2026, with recent samples showing average projected hikes ranging from 9.9% to 20.8%.

Coverage denials for chronic meds forcing patients to seek alternative options

By Alan Goforth - More than half of insured adults were told by their health insurance plan in the past year that their medication for a chronic or rare disease was no longer covered, and 48% were referred to an external company to help them obtain the needed drugs. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Loss of Insurance Coverage and Reliance on External Companies: A PAN Foundation poll found that a significant portion of patients with chronic or rare conditions who lost insurance coverage for essential medications were directed to work with external companies to secure treatment. The most common methods these companies used included importing medications from international pharmacies (44%), obtaining drugs through manufacturer patient assistance programs (43%), and leveraging charitable patient assistance foundations (40%). These arrangements often became the primary pathway for patients to continue accessing their prescribed therapies.

2. Treatment Delays and Adverse Health Effects: More than one-third of patients reported experiencing treatment delays ranging from one month to more than six months when working with external companies. Over 90% of these patients said the delays harmed their health—mentally (36%) and physically (32%)—and many faced compounding consequences such as unplanned visits to healthcare providers (30%), disruptions to daily living (29%), and emergency room or urgent care visits (25%). The findings indicate that these delays not only affect patient wellbeing but can also place added strain on the healthcare system.

3. Alternative Funding Outcomes and Ongoing Concerns: While slightly fewer than half of patients eventually had their medications covered again through insurance, many remained dependent on alternative funding solutions, including manufacturer patient assistance programs (42%), imported medications (32%), and charitable foundation support (32%). The study underscores the widespread use of these alternative funding programs and raises concerns about their potential to increase out-of-pocket expenses, contribute to prolonged care delays, and, in some cases, create life-threatening gaps in treatment access.

Experimental GLP-1 pill helped people with obesity lose weight, Eli Lilly says

By Amanda Sealy - In the first Phase 3 trial of its once-daily oral GLP-1 pill in people with obesity, drugmaker Eli Lilly said Thursday that it helped people lower their weight by an average of 12% after 72 weeks. Lilly, which makes the injectable drugs Zepbound to treat obesity and Mounjaro and Trulicity to treat diabetes, is among several companies chasing an effective pill form of GLP-1s. The only such pill available so far comes with strict diet restrictions and is approved to treat diabetes. Read Full Article…

HVBA Article Summary

1. Study Findings and Efficacy: In a trial of over 3,100 adults with obesity or overweight and at least one related medical condition (but without diabetes), the highest dose of orforglipron led to an average weight loss of 27.3 pounds (12.4% body weight). About 60% of participants lost at least 10% of their weight, and nearly 40% lost at least 15%. The study also reported improvements in cholesterol and blood pressure. These results are from company data and have not yet been peer-reviewed or published.

2. Side Effects and Comparisons: The most common side effects were gastrointestinal, including nausea, constipation, and diarrhea, similar to those of injectable GLP-1 drugs. Rates of some side effects were slightly higher than in Zepbound trials; for example, nausea occurred in 29% to 34% of orforglipron users versus 25% to 29% for Zepbound.

3. Potential Uses and Next Steps: Orforglipron is also being studied for maintaining weight loss after injectable therapies, which some experts believe could be a key long-term use. While oral GLP-1 drugs may not match injectables for maximum weight loss, they could be more convenient for ongoing management. Lilly plans to seek regulatory review by year-end, aiming for a potential global launch.

DOJ and UnitedHealth reach settlement on $3.3 billion Amedisys deal

By Tara Bannow - The Department of Justice and state officials have reached a proposed settlement agreement with UnitedHealth Group and Amedisys that would allow the companies to complete their $3.3 billion combination so long as they agree to sell 164 home health and hospice locations across 19 states. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Proposed Settlement to Resolve Antitrust Concerns: UnitedHealth’s acquisition of home health and hospice provider Amedisys will proceed under a proposed settlement that avoids a trial and addresses DOJ and multiple state attorneys general’s concerns over reduced competition. The agreement requires divesting certain Amedisys assets, worth about $528 million in annual revenue, to BrightSpring Health Services and The Pennant Group, with court approval and public comment still pending.

2. Settlement Terms and Compliance Measures: The agreement includes a $1.1 million civil penalty for Amedisys over inaccurate responses to federal document requests, mandates timely completion of divestitures, and establishes an independent court-appointed monitor to ensure compliance. It also protects transitioning employees by waiving noncompete and nondisclosure agreements, ensuring payment of owed compensation, and restricting targeted rehiring for 180 days.

3. Market Impact and Background Context: The DOJ initially sued to block the deal, arguing UnitedHealth would control significant portions of home health and hospice markets in multiple states. This settlement comes amid UnitedHealth’s broader expansion into various healthcare services, following acquisitions such as the 2023 purchase of LHC Group, and reflects the government’s insistence on strong competitors entering the market to preserve service and wage competition.

US appeals court reinstates drug-price conspiracy lawsuit against Sanofi, rival pharma companies

By Mike Scarcella - Drugmakers Sanofi, Eli Lilly, Novo Nordisk and AstraZeneca must face a lawsuit from two health centers accusing them of conspiring to restrict drug discounts offered to community pharmacies that contract with providers serving low-income patients. Read Full Article…

HVBA Article Summary

1. Court Ruling: The 2nd U.S. Circuit Court of Appeals in New York unanimously overturned a lower court’s dismissal, enabling Mosaic Health and Central Virginia Health Services to move forward with a proposed class action lawsuit. The case targets four major diabetes drug manufacturers, alleging that they unlawfully restricted access to 340B program discounts, which are intended to support safety-net healthcare providers.

2. Parties’ Positions: The two health clinic networks claim the drugmakers acted in concert in 2020 to impose restrictions on discounted diabetes drugs, making it easier to coordinate such limits given their market dominance. The defendants—Sanofi, Novo Nordisk, Eli Lilly, and AstraZeneca—deny the allegations, labeling the case as baseless and asserting that each company’s policies were independently created to address alleged fraud and abuse within the 340B program.

3. Case Context: Filed in 2021, the lawsuit argues that the manufacturers’ policies generated billions of dollars in additional profits for the companies while reducing resources for safety-net providers and the patients they serve. The drugmakers counter that their actions were within the bounds of the law, and note that participation in the 340B program is a requirement for pharmaceutical companies that seek reimbursement from federal health insurance programs such as Medicare and Medicaid.