Why Employers Predict a 10% Increase in Healthcare Costs for 2026

By Marissa Plescia - Employers in the U.S. are projecting a median increase of 10% in healthcare costs for 2026, a new survey from the International Foundation of Employee Benefit Plans found. The International Foundation of Employee Benefit Plans is a nonprofit focused on providing educational information to those working in the employee benefits industry. It has more than 31,000 employer members representing over 25 million lives. Read Full Article…

HVBA Article Summary

1. Healthcare costs are projected to rise significantly: Employers anticipate a 10% increase in medical plan costs for 2026, compared to the 8% rise projected last year. This marks a sharper upward trend, with organizations attributing the rise largely to catastrophic claims and expensive specialty prescription drugs, both of which have grown in influence compared to prior years.

2. Employers cite multiple cost pressures: Catastrophic claims were cited by 31% of respondents (up from 20% last year) as the top driver of rising expenses, followed by specialty/costly drugs at 23%, chronic conditions at 15%, and provider costs at 11%. Within the specialty drug category, GLP-1 drugs remain a factor but were named less often than last year (59% vs. 75%), while cancer treatments, cell and gene therapies, and other costly drugs also contributed significantly to overall concern.

3. Cost-control strategies are shifting: To manage these pressures, 27% of employers plan to adopt cost-sharing measures such as higher deductibles, copays, coinsurance, or premium contributions — a notable increase from 21% last year. Other approaches include plan design adjustments (17%), such as spousal surcharges or high-deductible plans, and provider-focused strategies (17%), including telemedicine and price transparency tools. Utilization controls, however, are declining in popularity, with only 12% citing them this year compared to 27% previously.

Health plan fiduciary risks are growing: Advisors hold the key to compliance

By Donovan Ryckis - With ERISA fiduciary oversight taking center stage in compliance conversations, benefits advisors have a unique responsibility to ensure employer clients know exactly where they stand. It’s not enough to talk about fiduciary duties in abstract terms; your clients need to understand whether their health and welfare plans are subject to ERISA in the first place. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. ERISA’s scope goes beyond retirement plans: Many employers still assume ERISA fiduciary duty only applies to retirement benefits, but in reality it extends to a broad range of health and welfare programs. This includes employer-sponsored medical, dental, and vision coverage, prescription drug benefits, disability and life insurance, FSAs/HRAs, wellness initiatives with medical services, and employee assistance programs. Recognizing this wider scope is essential for understanding the legal responsibilities employers take on when offering benefits.

2. Clarity on coverage and exemptions is essential: ERISA generally applies to private-sector employers who sponsor or administer benefit plans, but several categories of plans are exempt, including those offered by government entities, religious organizations, workers’ comp, unemployment programs, or certain voluntary and retiree-only plans. A common misconception is that using a fully insured plan automatically exempts an employer from ERISA, when in fact involvement in sponsoring or administering the plan still triggers ERISA obligations. Clear understanding of coverage versus exemption is critical to avoid costly mistakes.

3. Compliance is critical to reducing risk: For plans that fall under ERISA, employers must meet specific compliance requirements such as maintaining written plan documents, providing employees with a summary plan description (SPD), establishing claims and appeals processes, acting in the best interest of participants, and filing required reports like Form 5500 where applicable. Failure to follow these standards can lead to financial penalties, litigation, and erosion of employee trust. This makes proactive guidance from advisors invaluable in helping organizations reduce risk and maintain compliance.

Trump signs order to bolster API reserve: 5 notes

By Alexandra Murphy - President Donald Trump has signed an executive order aimed at increasing domestic production and stockpiling of essential drug components by directing the government to fill the nation’s Strategic Active Pharmaceutical Ingredients Reserve. Read Full Article…

HVBA Article Summary

1. Domestic Reliance on Imports: Currently, only about 10% of active pharmaceutical ingredients (APIs) used in U.S. drug production are manufactured domestically. The vast majority are imported from abroad, highlighting a heavy dependence on foreign suppliers and raising concerns about supply chain security for critical medicines.

2. Critical Drug Identification and Stockpiling: Within 30 days, the HHS assistant secretary for preparedness and response (ASPR) must create a list of approximately 26 drugs considered critical to U.S. health and national security. In addition, the ASPR is required to obtain and maintain a six-month supply of APIs for these drugs, ensuring that the existing SAPIR facility is ready to begin receiving and storing these supplies within 120 days.

3. Broader Planning and Funding Approach: Beyond immediate stockpiling, the order instructs the ASPR to prepare an updated strategy covering a broader list of 86 essential medications and to submit a proposal for opening a second SAPIR facility within one year. While no new congressional funding is requested, federal agencies are directed to identify and repurpose existing funds, with coordination from the Office of Management and Budget, to finance these operations.

Texas sues Eli Lilly for alleged kickback scheme to maximize Medicaid profits

By Alan Goforth - Pharmaceutical giant Eli Lilly bribed Texas health care providers to prescribe its most profitable drugs, state Attorney General Ken Paxton alleged in a lawsuit filed this week. “Big Pharma compromised medical decision making by engaging in an illegal kickback scheme,” he said. “Eli Lilly fraudulently sought to maximize profits at taxpayer expense and put corporate greed over people’s health. I will not stand by while corporations unlawfully manipulate our health care system to line their own pockets.” Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Allegations of Illegal Incentives: The Texas Attorney General’s lawsuit alleges that Eli Lilly provided improper inducements to medical providers, such as “free nurses” and reimbursement support services, in order to influence them to prescribe its medications. These practices, according to the lawsuit, resulted in prescriptions being written that were billed to Medicaid, leading to millions of dollars in allegedly fraudulent claims under the Texas Health Care Program Fraud Prevention Act.

2. Eli Lilly’s Response and Denial: Eli Lilly has firmly denied the accusations, emphasizing that similar claims brought in other cases have previously been rejected by multiple courts and federal authorities. The company maintains that its patient support programs are intended to ensure individuals can access and appropriately use prescribed medications. In statements, Eli Lilly reiterated its stance that the allegations are without merit and expressed its intent to vigorously contest the lawsuit in court.

3. Broader Legal Challenges: Beyond this lawsuit, Eli Lilly has faced a series of high-profile legal disputes over the past year. These include a separate action led by Texas against insulin manufacturers and pharmacy benefit managers over alleged price inflation, as well as a revived federal class action lawsuit accusing Eli Lilly and other major drugmakers of conspiring to limit a government-mandated drug discount program. Critics argue such actions increased costs for safety-net hospitals and clinics serving low-income patients, while raising broader concerns about pricing practices in the pharmaceutical industry.

Democrats question Oz on Medicare prior authorization pilot

By Rebecca Pifer - The CMS’ innovation center announced in late June that it planned to trial new prior authorization requirements in traditional Medicare in six states: New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington. The government will contract with private companies, including Medicare Advantage plans, to put prior authorizations in place for certain services, including skin and tissue substitutes and some knee surgeries. Read Full Article…

HVBA Article Summary

1. Balancing Cost Control and Care Access: Insurers maintain that prior authorization is an important tool to curb wasteful spending and reduce the number of unnecessary or overly costly medical procedures. However, critics emphasize that the process often creates heavy administrative burdens for doctors and hospitals, while also delaying or blocking care for patients. In some cases, these delays have been linked to poorer health outcomes, raising concerns about whether the financial savings justify the risks.

2. Medicare Policy Tensions: Traditional Medicare only rarely uses prior authorization, so the administration’s decision to test the practice raised alarm, especially since it coincided with efforts elsewhere to limit its use. Lawmakers and experts worry that the program could replicate restrictive patterns already seen in Medicare Advantage (MA), where denials of care are frequent. Notably, federal watchdog reports have shown that a large share of MA denials are later overturned on appeal, suggesting that patients are often wrongly denied coverage in the first place.

3. Lawmakers’ Concerns About Incentives and Burdens: A group of Democratic lawmakers argue that the proposed pilot program could unintentionally incentivize companies to limit access to services in order to maximize financial savings. Since contracted organizations may profit from cutting back on care, critics fear this creates a misalignment between patient needs and cost-control goals. On top of that, providers in the six test states would be required to participate, meaning they would shoulder an added “involuntary burden” in an already strained healthcare system.

10 best, worst states to live in

By Kristin Kucho - Massachusetts ranks as the best U.S. state to live in for 2025, driven by its high-quality healthcare system and education, according to WalletHub. The personal finance website’s list, published Aug. 11, evaluated states across five categories: affordability, economy, education and health, quality of life, and safety. More than 50 metrics were graded on a 100-point scale, with overall scores determined by a weighted average. Read Full Article…

HVBA Article Summary

1. Top-Performing States: Massachusetts, New Jersey, Wisconsin, Minnesota, and Utah stood out as some of the best places to live, with Massachusetts securing the #1 overall position. Their strong performance was driven largely by high scores in education, healthcare access, and life expectancy, which boosted their overall quality-of-life rankings.

2. Surprising Entries: States like Idaho, Florida, and Pennsylvania made it into the top 10 despite having only mid-range rankings in health and education. This indicates that other factors, such as affordability, economic opportunities, or quality of infrastructure, played an important role in lifting their overall scores.

3. Lowest-Ranked States: New Mexico, Louisiana, Arkansas, Mississippi, and Alaska were placed at the bottom of the list, reflecting ongoing challenges with healthcare outcomes, education quality, and general well-being. These states consistently ranked low across key measures that significantly impact residents’ quality of life.

Oracle Health debuts AI-powered EHR designed as a 'voice-first' solution embedded with agentic AI

By Heather Landi - Oracle Health launched its next-gen electronic health record solution equipped with the latest artificial intelligence and voice capabilities, which is designed to be easier for clinicians to navigate. The new "AI-first" EHR solution was designed from the ground up on Oracle Cloud Infrastructure and was not built on top of the existing Cerner infrastructure. Read Full Article…

HVBA Article Summary

1. Oracle’s New EHR Launch: Oracle unveiled a next-generation electronic health record (EHR) system aimed at U.S. ambulatory providers, pending final regulatory approval. The company plans to extend the platform to acute care settings by 2026, positioning it to serve a broader range of clinical environments. The new EHR introduces features such as voice-activated navigation, generative AI capabilities, and clinical intelligence, all designed to reduce manual clicks and streamline clinician workflows.

2. AI Integration and Design Approach: Instead of upgrading legacy technology, Oracle rebuilt the platform entirely in the cloud, embedding AI agents at its core. These agents are designed to act as contextual and conversational assistants, surfacing insights, supporting documentation, and guiding clinical tasks. The platform’s open architecture allows health systems to extend Oracle’s AI tools, develop their own, or integrate third-party models, offering flexibility while aiming to improve efficiency and consistency in care delivery.

3. Competitive Market Context: The release comes at a critical time as Oracle works to strengthen its position against leading competitor Epic, which has been steadily gaining market share in U.S. hospitals. Oracle’s portion of the acute care EHR market slipped to 22.9% in 2024, reflecting the loss of dozens of hospitals and thousands of beds, while Epic’s share climbed to 42.3% over the same period. Oracle’s new EHR, with its AI-driven features, represents part of its broader strategy to compete more effectively in the rapidly evolving healthcare IT landscape.