Employers brace for a 9% cost increase in 2026: Business Group on Health survey

By Paige Minemyer - Compounding healthcare costs may force some employers to take a hard look at the benefits they're offering to employees, according to a new survey. The Business Group on Health released its annual deep dive into employers' healthcare strategies Tuesday and found that these firms are bracing for median cost increase of 9% in 2026, following two years of increases that outpaced their forecasts. Read Full Article…

HVBA Article Summary

1. Rising Costs from GLP-1 Medications and Utilization Controls: The widespread use of GLP-1s and other weight-loss medications is driving costs upward, with 79% of employers reporting increased usage and 72% saying these drugs are having a “great” or “very great” impact on 2025 healthcare costs (up from 56% last year). To manage expenses, employers are expected to apply stricter protocols such as prior authorization, program participation requirements, or prescription restrictions. Some may also pull back on coverage altogether to achieve quicker cost reductions.

2. Cancer and Mental Health as Major Cost Drivers: Cancer remains the leading cost driver for the fourth straight year, fueled by rising diagnoses and expensive treatments. About half of employers plan to offer a cancer care center of excellence by 2026, and 23% are considering adding one by 2028. Mental health is also becoming a larger expense, with 73% of employers reporting increased use of mental health and substance use disorder services, and 17% anticipating further increases.

3. Shifting Vendor Strategies and Alternative Plans: Employers are scrutinizing the effectiveness of their benefits and reevaluating vendor relationships. Forty-one percent are seeking new or alternative pharmacy benefit managers (PBMs), and 51% are doing the same with medical or wellness vendors. Looking ahead to 2026, 24% of employers will offer an alternative health plan (with 36% considering it), while 27% will offer transparent PBM services (with 43% considering adoption). These moves aim to improve affordability and quality of care for employees.

Mark Cuban’s Cost Plus prices often higher than insurers' on neurologic medications

By Allison Bell - For U.S. patients with migraine headaches, epilepsy and Parkinson's disease, getting prescription drugs through an ordinary commercial health insurance plan is often cheaper than buying them through the Mark Cuban Cost Plus Drug Company, a team of neurologists reports. Dr. Hussain Lalani, a neurologist at Brigham and Women's Hospital in Boston, and five colleagues measured the performance of Mark Cuban's pharmacy by shopping there for 79 generic drugs frequently used to treat neurologic conditions. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Study Findings on Pricing: Researchers compared Mark Cuban’s pharmacy prices to those offered under typical commercial insurance plans. Out of the 33 drugs available through Cuban’s pharmacy, only 2 were priced lower than the average out-of-pocket amount paid by insured patients. Additionally, when factoring in the overall cost of the drugs, just 18 of the 33 came out cheaper than what would normally be paid through standard commercial health plans.

2. Impact on Aggregate Spending: The study projected that if every commercial prescription were filled using Cuban’s direct-to-consumer pharmacy model, total out-of-pocket spending would actually increase by approximately $82 million. This finding suggests that while the model may lower costs in certain cases, it would not consistently reduce expenses across the broader system compared to current pharmacy benefit manager (PBM) arrangements.

3. Broader Implications: These results may support the argument made by large PBMs that their negotiating strategies help hold down prescription drug costs for patients. However, the researchers also noted that further studies could reveal different outcomes depending on the drug set examined. The takeaway is that no single approach—whether PBMs or transparent direct-to-consumer pharmacies—appears to always provide the lowest prices, meaning cost-conscious patients may benefit from comparing multiple sources rather than relying on one option.

Republicans and Democrats must agree: Americans deserve price transparency in health care

By Roger Marshall - Reducing America’s outrageous health care costs is a top bipartisan priority of this Congress. The Patients Deserve Price Tags Act, a new bipartisan bill I introduced with Sen. John Hickenlooper (D-Colo.), can reverse runaway health expenditures that are burdening Americans of all backgrounds by requiring actual prices throughout the health care system. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Rising Health Care Costs and Impact on Americans: U.S. health care spending has surged to approximately $5 trillion annually, nearly 20% of GDP, more than double the amount in 2000 when adjusted for inflation. This rapid increase has left 100 million Americans in medical debt and placed pressure on workers, as employer-sponsored premiums have risen by 50% in the past decade, contributing to stagnant take-home pay and limiting wage growth.

2. Price Transparency as a Proposed Solution: Advocates of reform point to the lack of clear, upfront pricing as a major driver of inflated medical bills, with patients often charged thousands of dollars for routine procedures. The Patients Deserve Price Tags Act seeks to require providers and insurers to publish real, upfront prices — including both cash discounts and negotiated insurance rates — to give patients, employers, and unions the ability to compare options, encourage competition, and avoid overbilling practices that currently remain hidden.

3. Economic and Systemwide Implications: Supporters estimate that nationwide price transparency could reduce health care expenditures by about $1 trillion annually by curbing waste, overcharges, and fraud, which studies suggest account for nearly a quarter of spending. The legislation would strengthen compliance with existing rules, expand them to include more facilities such as labs and surgery centers, and increase enforcement against noncompliant hospitals, with the goal of fostering a more efficient system that enjoys bipartisan support and overwhelming public approval.

Benefits Think: 5 strategies for attracting talent without breaking budgets

By Marcy Klipfel – In today's hiring market, employers are facing a delicate balancing act when it comes to employee benefits. On one side of the scale, employee expectations for benefits have never been higher — particularly among millennial and Gen Z workers. On the other, healthcare costs continue to rise, stretching already tight HR budgets. It's no wonder, then, that the more than 1,300 HR professionals surveyed by Businessolver last year were evenly split among their top benefits priorities: engaging their workforce and managing costs. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Flexibility and Well-Being Drive Value: Employees consistently rank flexibility above pay increases, and it remains one of the lowest-cost benefits to implement. Flexible arrangements such as hybrid work or compressed schedules can significantly improve attraction and retention. Meanwhile, 50% of employees report experiencing mental health issues, and while 92% in 2025 want extended mental health benefits, only 22% have access. This gap shows how combining flexibility with stronger well-being support can deliver meaningful improvements without major expense.

2. Choice and Personalization Matter: With a multigenerational workforce, variety in benefits is essential. Gen Z seeks six times more “delighter” benefits than baby boomers, seeing them as reflections of company culture and values. Examples include wellness programs, financial support, or care navigation services. Pairing these with AI-driven personalization and clear communication ensures employees not only have the right options but also understand and maximize them, creating greater satisfaction and cost efficiency.

3. Cost-Sharing Strengthens Packages: Employees are often willing to contribute financially to benefits they value. Even 100% employee-paid voluntary benefits can carry strong appeal when offered at discounted group rates and made easy to access alongside core benefits. By identifying which benefits resonate most and structuring cost-sharing fairly, employers can expand offerings while keeping costs sustainable. This positions benefits as a partnership, giving organizations a competitive edge in retaining and attracting talent.

Pharmacy Barriers Can Hinder Telehealth Treatment for Opioid Addictions

By Shannon Firth - A large proportion of opioid use disorder (OUD) patients getting care via telemedicine reported missed buprenorphine doses over the past year due to pharmacy-related barriers, a cross-sectional study found. Among 601 OUD patients who responded to a survey, 31.9% reported missing buprenorphine doses due to problems filling their prescriptions, according to Marlene C. Lira, MPH, of Workit Health in Ann Arbor, Michigan, and colleagues. Read Full Article…

HVBA Article Summary

1. Primary Cause of Fill Problems: The leading reason patients experienced difficulty filling buprenorphine prescriptions was pharmacies’ need for additional stock (54.5%). Other contributing issues included insurance barriers (22.4%), hesitancy to fill telemedicine prescriptions (19.4%), and logistical or policy-based limitations such as order caps or pharmacies not carrying the medication.

2. Geographic and Patient Impact: Rates of fill problems varied by state, with Florida reporting the highest (45.5%) and Ohio the lowest (22%). Resolution rates also differed, from 80.3% in Michigan to 93.3% in Florida. Some patients missed doses due to these problems, with up to a quarter experiencing interruptions of seven days or longer.

3. Regulatory and Systemic Challenges: Despite federal actions to ease prescribing—such as telemedicine allowances and elimination of the X waiver—pharmacy-level barriers remain. Policies linked to opioid settlement agreements and DEA monitoring systems may unintentionally restrict access. Experts note that telemedicine prescriptions should not automatically raise concerns, and proposals are emerging to require minimum stocking and adjust federal reporting rules.

Employers urged to prioritize dental care as a critical component of whole-person health

By Alan Goforth – The importance of mental, physical and financial health to overall wellbeing has been highlighted in numerous studies and surveys in recent years. A new study from Cigna Healthcare adds dental health to that list. Oral health problems such as tooth decay, dental pain, gum disease and tooth loss have long been connected to mental health as a collateral effect often attributed to diminished overall self-care or a lack of interest in health or appearance. Read Full Article... ^{_{(Subscription required)}} 

HVBA Article Summary

1. Strong Oral–Mental Health Link: Research highlights a powerful two-way connection between oral health and mental health. Patients with severe mental illness are 2.7 times more likely to lose all their teeth, and conditions like periodontitis cause chronic inflammation that can enter the bloodstream, elevating stress hormones and worsening mental health. This demonstrates how oral health issues can both result from and contribute to broader health challenges, making dental care a critical part of overall wellbeing.

2. Barriers and Equity Issues in Dental Care: Significant obstacles continue to limit access to proper dental care. High costs, racial bias in the delivery of services, shortages of dental providers, and limitations in data exchange between carriers and providers all contribute to disparities. As a result, nearly one-third of people surveyed reported not having visited a dentist in over a year. These barriers make oral care one of the most overlooked equity issues in healthcare, with underserved communities and rural populations facing the steepest challenges.

3. Innovations and Employer Role in Expanding Access: New technologies and approaches are helping close these gaps in dental care. Tools like teledentistry allow patients to triage oral issues remotely, AI-powered at-home screenings give early insights, and mobile dentistry brings essential services such as X-rays and fillings directly to workplaces. Employers play an especially important role by incentivizing preventive visits, negotiating discounts on home oral care tools, and integrating dental benefits into broader wellness strategies. These measures not only improve employee health but also help reduce overall healthcare costs and support productivity.

Leverage Healthcare Pricing Data for Plan Design and Cost Management

By Claritev - Limited insight into the true price of elective healthcare services puts plans, brokers and their clients at a disadvantage. They may struggle to negotiate appropriate reimbursement rates, design cost-effective plans and create high-quality networks. Under these circumstances, they lose money. At the same time, mounting cost pressure are prompting employers to act. The largest brokerage firms in the country project that health benefit costs will rise between 6% and 9% this year. Read Full Article…

HVBA Article Summary

1. Policy and Market Pressure on Price Transparency: Recent federal regulations, including Transparency in Coverage and Hospital Price Transparency rules, along with executive orders, are pushing hospitals and health plans to make pricing data publicly available. This increased scrutiny reflects a broader policy effort to hold the healthcare industry accountable, encourage competition, and help keep costs manageable for patients, employers, and insurers.

2. Challenges of Using Raw Pricing Data: Although vast datasets on hospital and health plan pricing are now accessible, they often contain billions of records and are difficult for plans and brokers to interpret. Simply having access to these numbers is not enough—stakeholders need reliable, current, and standardized data, as well as analytics tools that can transform raw information into actionable insights for setting reimbursement rates and designing effective networks.

3. Analytics as a Competitive Advantage: Platforms such as Claritev’s PlanOptix aim to address these challenges by offering both large-scale coverage and advanced analytics capabilities. By applying quality ratings to data and contextualizing costs relative to Medicare benchmarks and other providers, these tools allow plans and brokers to negotiate more effectively, build high-performing networks, and expand into underserved markets. This creates a competitive edge while also supporting affordability and improved patient access to high-quality care.