Telehealth Safe Harbor Is A Win-Win For Workers And Employers 

By Ami Parekh – The One Big Beautiful Bill signed into law on July 4 contains some of the most consequential changes to U.S. healthcare policy since the Affordable Care Act. While many healthcare stakeholders — from physicians and employers to patients and policymakers — are justifiably concerned about the projected impact on insurance coverage and access to care, the bill contains an important and largely overlooked bright spot: pre-deductible telehealth coverage for people enrolled in high-deductible health plans (HDHPs). Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Permanent Safe Harbor for Telehealth and HSAs: The bill permanently reinstates the safe harbor policy, originally created during the Covid-19 public health emergency, which lets employers provide pre-deductible telehealth services to people in high-deductible health plans (HDHPs) without affecting their health savings account (HSA) eligibility. This affects a large share of the workforce, since more than 20% of working-age Americans with private insurance are enrolled in HDHPs.

2. Broad Support and Utilization Trends: Employer and bipartisan support for the policy is strong: 76% of employers surveyed by the Employee Benefit Research Institute (EBRI) favored making it permanent, and more than 80% of health plans serving self-funded employers reduced or eliminated cost-sharing for telehealth during the pandemic. Around two-thirds of private employers expanded or encouraged virtual care, and roughly half of all Americans have now had at least one virtual visit — using it for needs ranging from urgent care to mental health and chronic condition management.

3. Long-Term Role of Virtual Care in Access and Cost Savings: Virtual care has become a mainstream part of U.S. healthcare, particularly important amid physician shortages and access barriers. Research shows HDHP enrollees are more cost-sensitive than other employees, often delaying preventive care and risking higher downstream costs like ER visits. The safe harbor provision helps reduce direct costs (e.g., copays) and indirect costs (e.g., lost wages, transportation), offering employees a more convenient option for essential care while enabling employers to support workforce health and productivity.

'Catastrophic' claims drive a projected 10% rise in employer health costs

By Michael Popke – U.S. employers project a median health care cost increase of 10% for 2026, according to new survey results from the International Foundation of Employee Benefit Plans. A similar Foundation survey conducted in 2024 projected a median cost increase of 8% for 2025. “The 10% projected increase is attributed to a variety of factors impacting organizations’ medical plan costs, with catastrophic claims and specialty/costly prescription drugs topping the list,” Julie Stich, vice president of content at the Foundation, said in a statement. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Projected Cost Trend and Source: Employers project a median 10% increase in health care costs for 2026, up from a projected 8% increase for 2025, based on a Foundation survey. The data were collected from corporate and single employers between July 30 and Aug. 7 and are presented in the International Foundation of Employee Benefit Plans' “Pulse Survey: 2026 Cost Trend” report. The report is intended to inform U.S. plan sponsors about expected health care costs and management approaches for the coming year.

2. Primary Drivers of the Increase: Respondents identified catastrophic claims as the top factor (31% of respondents), followed by specialty/costly prescription drugs (23%), utilization from chronic conditions (15%), and medical provider costs (11%). The share citing catastrophic claims rose notably from 20% last year, while specialty drug concerns point specifically to GLP-1 drugs, cancer therapies, and cell and gene treatments. These factors together are cited as the main contributors to the projected 10% cost rise.

3. Preferred Cost-Management Strategies: Employers indicated cost-sharing measures (27%) such as higher deductibles and copays would be most impactful, followed by plan design changes (17%) and purchasing/provider initiatives (17%) like telemedicine and price-transparency tools. Purchasing/provider initiatives showed an increase from 9% last year, while utilization-control initiatives declined to 12% from 27% the prior year. The survey suggests employers are shifting toward designs and provider-focused approaches alongside traditional cost-sharing to manage rising medical plan costs.

Employers Predict 9% Health Care Cost Jump in 2026

By Emily Boyle - Employers expect to continue facing a health care cost crunch in the year ahead, according to the Business Group on Health, a nonprofit group supporting companies’ interests in health care. According to the organization’s 2026 Employer Health Care Strategy Survey, released today, employers predicted health care cost increases for 2026 will come at a median of 9% greater than current levels, offset against 7.6% savings stemming from plan design changes. Read Full Article…

HVBA Article Summary

1. Rising Health Care Costs and Forecast Gaps: Employers continue to underestimate health care cost growth. In 2023, costs were predicted to rise 6.6% but actually grew 6.8%, and in 2024, a 7.1% forecast was outpaced by 7.5%. Looking ahead, employers project an 8.0% increase in 2025, and on a compounded basis, costs in 2026 are expected to be 62% higher than 2017 levels. These steady overruns highlight the mounting difficulty of containing expenses while still providing comprehensive benefits.

2. Pharmacy and Specialty Drug Pressures: Pharmacy spending now accounts for 24% of overall employer health costs, up from 21% in 2021. GLP-1 medications and other high-cost therapies are the most significant drivers: 72% of employers said GLP-1s are pushing costs “greatly” or “very greatly,” while 61% cited other specialty drugs. To offset rising prices, 41% of employers are changing or reevaluating their pharmacy benefit managers, and many are turning to utilization management strategies like prior authorization and linking coverage to participation in weight management programs.

3. Cancer, Mental Health, and Access to Care as Priorities: Cancer has overtaken other conditions as the top driver of costs, with 74% of employers already seeing higher expenses and 17% anticipating more in the coming years. Preventive measures are expanding, including breast cancer screenings projected to rise from 25% of employers in 2024 to 43% by 2026. At the same time, mental health remains a key cost factor: 73% of employers report higher expenses from increased use of services, and 98% already have programs in place. Nearly half plan to add access to specialized cancer or acute mental health centers by 2026, showing an emphasis on both financial control and workforce support.

CVS Health's Caremark, other PBMs face $1.7M in fines in West Virginia

By Allison Bell – West Virginia has imposed at least $1.7 million in civil penalties on pharmacy benefit managers so far this year, according to a review of final orders posted on the website of the West Virginia Offices of the Insurance Commissioner. West Virginia began to license PBMs in 2020. The PBMs fined violated the West Virginia PBM licensing requirements, according to the consent orders and other filings describing the fines. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Multiple PBMs fined by West Virginia regulators: Two CVS Health affiliates, Caremark and CaremarkPCS Health, were ordered to pay a combined $1.4 million in fines. Additional penalties were imposed on other pharmacy benefit managers (PBMs), including $160,000 on Cigna’s Express Scripts unit, $66,000 on Rightway PBM Services, $64,000 on WellDyne, and $32,750 on Pharmacy Benefit Dimensions. Altogether, West Virginia regulators issued $493,000 in PBM fines in 2024, underscoring the state’s heightened scrutiny of PBM practices.

2. Dispute and settlement over regulatory interpretation: Representatives from Caremark explained that the fines were connected to differences in how the company and state regulators interpreted rules surrounding pharmacy audits, reimbursement practices, and related oversight. While Caremark expressed concern that such regulatory interpretations could lead to higher costs for consumers and health plans, they noted that they worked closely with the West Virginia Offices of the Insurance Commissioner to resolve the matter. The insurance commissioner’s office confirmed a settlement had been reached, and Caremark’s appeal was dismissed, though a formal order reflecting the agreement has yet to be issued.

3. Context of healthcare challenges in West Virginia: These fines and disputes are set against a broader backdrop of systemic healthcare challenges in West Virginia, where residents face widespread economic hardship, high rates of chronic health conditions, and limitations in healthcare access. Nearly 30% of residents live far from a retail pharmacy, making West Virginia one of the hardest-hit “pharmacy deserts” in the U.S. This environment has intensified the debate over PBM practices, as they play a significant role in shaping medication availability and affordability in the state.

Good News on GLP-1s and Cancer Risk, With One Exception

By Charles Bankhead – Patients taking GLP-1 agonists for weight loss had a small but significantly lower risk of developing cancer, a large retrospective cohort study showed. With follow-up ranging from 1 to 11 years, use of GLP-1 agonists, such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound), was associated with a 17% lower cancer risk as compared with non-users. Cancer incidence was lower for 12 of 13 recognized obesity-related cancers, plus lung cancer, and the difference between users and non-users reached statistical significance for endometrial and ovarian cancers and meningioma. Read Full Article...

HVBA Article Summary

1. Overall Association with Lower Cancer Risk: A large retrospective cohort study comparing 43,317 GLP-1 agonist users with 43,315 non-users found an overall 17% lower cancer risk (HR 0.83, 95% CI 0.76-0.91, P = 0.002) among users. Incidence trended lower for 13 of 14 cancers examined and reached statistical significance for endometrial cancer, ovarian cancer, and meningioma. Because the study is observational, the association does not establish causation and requires validation in further research.

2. Kidney Cancer Was an Outlier: Kidney cancer showed a non-significant increased hazard ratio of 1.38 (95% CI 0.99-1.93) among GLP-1 agonist users, with higher risk observed in patients younger than 65 and those who were overweight rather than obese (BMI 27–29.9). The authors noted that a clear biological explanation is lacking, particularly given reports that GLP-1 agonists can improve kidney function. This signal warrants targeted investigation to determine whether it represents a true risk or a chance finding or confounding.

3. Study Limitations and Public Health Context: The analysis was retrospective and relied on electronic health record data and machine-learning modeling, with no longitudinal BMI or glycemic-control data to disentangle drug effects from weight-loss effects. The authors emphasize that because an estimated 137 million individuals in the U.S. are eligible for GLP-1 receptor agonist therapies, even modest changes in cancer risk could have substantial public health implications. Randomized or prospective studies would provide stronger evidence but face logistical challenges such as large sample sizes and dropout over time.

Hospital Margins Grow, Yet Bad Debt & Expenses Continue to Climb

By Katie Adams - Financial performance among U.S. hospitals improved toward the end of this year’s second quarter — but there are still concerning gaps between the highest- and lowest-performing organizations, according to new research released by Kaufman Hall. The consulting firm analyzed data from 1,300 hospitals across the country and found that hospitals’ financial margins improved to 3.7% in June, up from 1.9% in May. Read Full Article…

HVBA Article Summary

1. Revenue Growth Trends: Hospitals are seeing growth in revenue on a volume-adjusted basis, meaning they are earning more per patient rather than simply relying on higher patient volumes. A significant portion of this improvement comes from increases in outpatient revenue, which suggests that hospitals are learning how to better utilize and expand their outpatient facilities as part of their broader care strategies.

2. Operational Strategies for Stability: High-performing hospitals are characterized by their ability to adapt quickly on both the revenue and cost sides. This often includes diversifying services, expanding outpatient footprints, centralizing functions to reduce expenses, and embracing alternative care models like value-based or bundled care. For smaller hospitals, the recommendation is to focus on operational discipline—such as tightening daily processes and accurately capturing owed revenue—to ensure near-term stability and to strengthen their position for potential partnerships or affiliations in the future.

3. Ongoing Financial Pressures: Even with modest improvements, hospitals continue to face rising financial challenges. Bad debt grew in June at a faster rate than in prior months, which may reflect shifts in patient coverage under public programs like Medicaid. At the same time, non-labor expenses and costs tied to purchased services are steadily climbing. These financial pressures highlight that without ongoing efficiency improvements and rigorous revenue management, hospitals—particularly those already financially weaker—could become more vulnerable to instability.

FDA Approves First-in-Class Drug for Fibromyalgia

By Megan Brooks - The FDA has approved cyclobenzaprine hydrochloride sublingual tablets (Tonmya, Tonix Pharmaceuticals), a first-in-class, nonopioid treatment for adults with fibromyalgia, a chronic pain syndrome that affects more than 10 million Americans, roughly 80% of whom are women. Read Full Article…

HVBA Article Summary

1. First New FDA-Approved Fibromyalgia Therapy in Over 15 Years: Tonmya (sublingual cyclobenzaprine, formerly TNX-102 SL) represents a major milestone as the first new therapy approved by the FDA for fibromyalgia in more than a decade and a half. Taken once daily at bedtime, it targets nonrestorative sleep, a key underlying factor that contributes to pain, fatigue, and brain fog in patients. The medication is expected to become available to patients in the fourth quarter of this year, offering a long-awaited new treatment option.

2. Strong Evidence of Efficacy From Phase 3 Trials: In two large, well-controlled phase 3 clinical trials (RELIEF and RESILIENT) involving nearly 1000 patients with fibromyalgia, Tonmya demonstrated statistically significant reductions in daily pain scores compared to placebo at 14 weeks, meeting its primary endpoint. Importantly, a higher proportion of patients experienced a clinically meaningful improvement (≥30%) in their pain after 3 months of treatment compared to placebo. While a third trial (RALLY) involving over 500 patients showed a greater but nonsignificant treatment effect, the overall body of evidence strongly supports Tonmya’s benefit.

3. Well Tolerated With Manageable Side Effects: Across all three phase 3 studies, Tonmya was generally well tolerated and did not lead to any serious safety concerns. The most common side effects were relatively mild and localized, including oral discomfort, dry mouth, and canker sores, as well as systemic effects such as fatigue and drowsiness. These findings suggest that while some patients may experience tolerability issues, the therapy overall has a favorable safety profile, particularly given the unmet need for effective fibromyalgia treatments.