Medical billing vendor data breach affects 3.8M

By Allison Bell – Employer health plan participants are still getting new notices about medical record data breaches. Unlimited Systems, a Cincinnati-based medical billing system company, has reported that it's now sending notices about a breach that affected 3.8 million people associated with the 4,500 medical offices and 6,500 health care providers that use the company's billing systems. Most of the people getting the breach notices are patients. Unlimited focuses on serving medical specialists, such as dermatologists, optometrists and oncologists. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Scope, timeline, and investigation details: Unlimited Systems said it discovered the incident on Oct. 19 and hired a cybersecurity forensic firm to investigate. The company reported that an “unauthorized actor” may have accessed personal information over a window from Oct. 5, 2025, through Oct. 10, 2025. The article indicates the affected population is largely patients tied to provider offices using Unlimited’s billing systems.

2. Potential data exposed and consumer support offered: The breach notice referenced in the article suggests exposed information may include sensitive identifiers such as Social Security numbers and insurance cards. Unlimited is offering two years of free credit monitoring through Kroll to people affected. The article notes this credit-monitoring offer is available to affected people in California, as reflected in the notice posted to the state attorney general’s breach notification site.

3. Broader pattern and implications for employers and advisors: The article places the incident in a wider wave of attacks against insurers, benefit administrators, and related vendors. It compares the breach’s scale to other disclosed events, including a TriZetto medical billing system breach and a much larger Aflac breach. For employers and benefits advisors, the incident is presented as a reminder of persistent cybersecurity challenges and the risks of relying on Social Security numbers for participant identity verification.

Court battles leaving the 340B program in legal limbo

By Ella Jeffries – AbbVie and Novartis each sued Illinois Aug. 7 in the Northern District of Illinois, seeking to block the state’s new 340B contract pharmacy law. Three days later, a federal judge in South Dakota dismissed three lawsuits from AbbVie, AstraZeneca and the Pharmaceutical Research and Manufacturers of America (PhRMA), challenging that state’s nearly identical law. Over the past 18 months, the drug discount program has turned into one of the most litigated corners of healthcare, on two separate fronts. Drugmakers are suing states that bar manufacturers from restricting which contract pharmacies can dispense 340B drugs. At the same time, hospitals are suing drugmakers, PBMs and HHS over practices they say are draining hundreds of millions of dollars out of the program. Becker’s has been tracking the litigation and policy shifts all year. Read Full Article...

HVBA Article Summary

1. State contract-pharmacy laws are producing uneven results across federal circuits: The article describes how manufacturer challenges to “contract pharmacy access” laws are being decided differently depending on the jurisdiction, leaving the legal landscape unsettled. Some rulings have favored drugmakers while others have upheld state laws, and at least one circuit is revisiting earlier decisions through en banc review. This creates uncertainty for states that recently enacted similar statutes and for manufacturers deciding whether to continue or expand litigation.

2. A second, parallel wave of lawsuits targets PBMs, manufacturers, and federal agencies over alleged program erosion: Beyond the state-law disputes, health systems are bringing cases alleging that intermediaries and manufacturers are diverting or reducing 340B value that covered entities expect to receive. The article highlights litigation alleging large sums of 340B savings were redirected through reimbursement practices and contract disputes, alongside legal fights over shifting from upfront discounts to rebate-style models. These cases expand the battlefield from state legislatures and attorneys general to private contractual relationships and federal oversight questions.

3. Program growth and Inflation Reduction Act ‘duplicate discount’ concerns are central drivers of the surge: The article attributes the escalation to 340B’s expansion since 1992—particularly through contract pharmacy networks—and to manufacturers’ arguments that the program now functions more broadly than originally intended. It also notes that Medicare rebate provisions in the Inflation Reduction Act have introduced ambiguity around what constitutes an impermissible “duplicate discount,” which both sides are using to support opposing positions. With multiple appellate cases still pending and federal pilot-model changes underway, the article suggests the disputes are likely to continue rather than resolve quickly.

Claims data transparency empowers employers to act on affordability: survey

By Paige Minemyer – Employers that have access to key data on their healthcare spending and costs are more likely to take steps to address affordability and pharmacy benefit transparency, a new survey shows. The National Alliance of Healthcare Purchaser Coalitions polled 408 employers, ranging from small companies to jumbo firms, for its annual Pulse of the Purchaser survey. It found that these firms cited three top sources of affordability barriers: drug prices (77%), high-cost claims (75%) and hospital prices (68%). Read Full Article...

HVBA Article Summary

1. Better data access correlates with more cost-control actions: The survey indicates that employers with stronger visibility into claims and cost data tend to deploy a wider set of high-value purchasing tactics. Examples described include direct contracting, using centers of excellence, and shifting care to lower-cost sites when appropriate. The implication is that transparency can help employers move from general concern about affordability to specific operational decisions. The article also notes that some employers depend on their health plans for access to data, which can affect how information is presented and used.

2. Employers are signaling growing willingness to rethink PBM arrangements: Pharmacy benefit transparency and PBM reform are presented as major priorities among respondents, with a large majority viewing reform as helpful. The article reports that many employers are considering changing PBMs within the next three years, indicating active scrutiny of existing arrangements. It also describes a shift in employer thinking from “rebate maximization” toward a “lowest net cost” approach. Larger employers appear more cautious about switching quickly, in part due to questions about whether alternative PBMs can scale to their needs.

3. Hospital cost transparency is framed as a policy and contracting lever: Respondents increasingly see hospital price transparency, rate regulation, and antitrust enforcement as helpful reforms, according to the survey results cited. The article suggests that having clearer pricing information can support strategies like tiered incentives, narrower networks, and steering patients toward higher-value providers. Direct contracting is highlighted as another approach employers are exploring to address hospital costs. The interviewee argues that transparency can give employers greater confidence when negotiating directly because they better understand their baseline spending and targets.

Eli Lilly, Novo Nordisk win dismissal of GLP-1 antitrust case

By Kristen Smithberg – A federal judge has dismissed with prejudice a compounding pharmacy's antitrust lawsuit accusing Eli Lilly and Novo Nordisk of restricting access to lower-cost, customized versions of their blockbuster GLP-1 drugs. U.S. District Judge Micaela Alvarez of the Western District of Texas ruled that Strive Specialties failed to define a legally valid product market or show an injury covered by federal antitrust law. Strive filed the lawsuit in January, alleging the drugmakers used exclusive agreements with major telehealth providers to prevent the platforms from fulfilling prescriptions through compounding pharmacies. The company also accused Lilly and Novo Nordisk of questioning the safety of compounded drugs to discourage patients and providers from using them. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Why the court dismissed the antitrust claims: The judge concluded Strive Specialties did not plead a legally valid product market and did not show the type of injury federal antitrust laws are meant to address. A central issue was whether individualized compounded GLP-1 medications compete in the same market as standardized branded products. The court said the decision to use a compounded drug turns on medical necessity rather than typical consumer substitution, which weakened Strive’s market-definition theory.

2. Compounding rules and the role of shortages: The article explains that compounding pharmacies were broadly permitted to make copies of semaglutide and tirzepatide products while the FDA listed the branded drugs as being in shortage. After shortages ended, pharmacies generally could not continue producing large-quantity copies. The piece notes that compounding may still be allowed for individual patients when a commercial product cannot meet specific medical needs, such as a required dosage, delivery method, or formulation.

3. What the ruling leaves open and what comes next: The court did not fully reject Strive’s contention that cash-paying GLP-1 patients could be a distinct submarket, given that insurance exclusions and utilization controls can shape purchasing options. However, the judge did not decide that issue because the lack of competition between compounded and branded products was enough to defeat the Sherman Act and Clayton Act claims. Because the dismissal was with prejudice, Strive cannot refile the same claims in district court, though it may seek appellate review; the article also reports statements from Strive, Lilly, and Novo Nordisk in reaction to the decision.

How smaller businesses can keep their benefits cost-effective and competitive

By Lee Hafner – Rising healthcare costs, inflation, and evolving employee demands can make building a competitive benefits package challenging for small and medium-sized businesses, but their ability to provide quality offerings and more personalization can go a long way in capturing talent. New research from professional employer organization Justworks and The Harris Poll revealed 96% of small business owners who are worried about hiring and retention say it's important to offer employees more variety in terms of health coverage, and 49% worry their current benefits aren't going to cut it. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Small Businesses Can Compete Through Targeted Benefits: Small employers do not necessarily need to match larger companies’ benefits spending or offer a large number of plan choices to attract and retain talent. Their closer relationships with employees can help them identify which benefits workers actually value and select more targeted offerings. Feinberg suggests that two or three well-chosen plans may be more effective than offering five or six options that add cost and complexity.

2. Long-Term Budgeting and Clear Metrics Should Guide Benefits Decisions: Employers should develop a three- to five-year benefits budget that accounts for inflation, rising health insurance costs, and potential additions to the benefits package. Using the entire available budget in the first year can create pressure to reduce benefits later as costs increase. Employers should also define success metrics for each benefit based on the specific problem it is intended to address, such as utilization, access to care, or ease of use.

3. Employers Should Evaluate Cost-Effective Funding and Coverage Options: Working with benefits experts can help smaller employers assess options such as high-deductible health plans paired with HSAs and Individual Coverage Health Reimbursement Arrangements (ICHRAs). HDHPs combined with HSAs can provide tax advantages and a potential savings vehicle, while ICHRAs may give employers greater control over healthcare contributions and flexibility for multistate or distributed workforces. The broader objective is to ensure benefits spending aligns with employee needs and delivers sufficient value rather than assuming higher-cost offerings are automatically better.

8 GLP-1 updates to know

By Ella Jeffries – New research is reshaping how clinicians think about GLP-1 use across pregnancy and obesity care, alongside major legal and financial developments for the drugs’ top manufacturers. Here are eight GLP-1 updates to know. Read Full Article...

HVBA Article Summary

1. Legal and regulatory oversight is evolving around GLP-1 access and markets: A federal judge dismissed a compounding pharmacy’s antitrust lawsuit against Eli Lilly and Novo Nordisk, citing a failure to allege a legally cognizable product market. Separately, CMS plans to begin sharing monthly GLP-1 Bridge utilization data with Part D plans this fall, increasing payer visibility into use of the program. Together, these developments point to continued scrutiny of how GLP-1 therapies are distributed and monitored across the healthcare system.

2. Manufacturer performance and competitive dynamics remain in focus: Eli Lilly reported second-quarter revenue of $22.97 billion, up 48% year over year, and the article notes this widened its GLP-1 revenue lead over Novo Nordisk. Novo reported about $12.3 billion in net sales, up 3%, and the company raised its full-year outlook. The update also highlights that Novo’s oral Wegovy pill surpassed 5 million U.S. prescriptions, indicating ongoing product and formulation competition despite differing financial trajectories.

3. Clinical guidance and research are expanding GLP-1 use cases beyond weight loss alone: An international expert panel reviewed 34 studies and published consensus guidelines on incretin-based medications around pregnancy, noting no reported increased risk of congenital anomalies while recommending discontinuation once pregnancy is confirmed. The article also describes research suggesting GLP-1 therapies could support more personalized obesity care based on cardiometabolic needs, with different agents showing varying strengths across outcomes. In addition, the VA is launching a clinical trial enrolling more than 600 veterans to test whether semaglutide can treat alcohol use disorder, reflecting growing interest in potential benefits beyond obesity and diabetes.

Knowing what to cut matters more than what to add

By Tom Murphy – Spend enough time in rooms with CHROs and benefits leaders and a pattern emerges that no one quite wants to say out loud: the companies winning on benefits right now aren't winning by offering more. They're winning by being honest about what isn't working. That admission is quiet, uncomfortable and increasingly unavoidable. And it's reshaping the industry, including benefits advising. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Employers Shift from Adding Benefits to Optimizing Existing Programs: With 79% of employers expecting benefits budgets to remain flat or increase only slightly, organizations are placing greater scrutiny on underused or ineffective programs. Although 73% of employees say more benefits could increase loyalty, fewer than half believe their current offerings meet their needs. This suggests employers may increasingly prioritize relevance, utilization and measurable value over the overall number of benefits offered.

2. Personalization and Workforce Fit Become Greater Priorities: More than half of employees say their health and wellbeing benefits feel irrelevant to them, while 80% report that personalized options would increase their engagement. Tailored wellbeing programs have been associated with a 5.5% reduction in turnover, while replacing an employee can cost roughly one-third of that worker’s annual salary. Employers are therefore looking beyond standardized benefit packages toward offerings that reflect different health, financial, mental health and caregiving needs.

3. Brokers and Advisers Face Growing Demand for Strategic Guidance: As employers evaluate which programs to retain, replace or eliminate, brokers and advisers may have a larger role in analyzing workforce needs and helping clients allocate limited benefits dollars. The focus is shifting from presenting a broad menu of products toward developing strategies based on employee demographics, organizational culture, engagement and utilization. A more targeted portfolio could reduce administrative complexity for employers while potentially increasing employee participation and strengthening the long-term value of the broker-client relationship.