Federal judge blocks FTC's nationwide noncompete ban

By Dave Muoio - A Texas federal judge has struck down the Federal Trade Commission’s rule broadly banning employers’ noncompete agreements 15 days before it was set to go into effect nationwide. Read Full Article…

HVBA Article Summary

1. Judicial Ruling and Legal Implications: U.S. District Judge Ada Brown ruled against the Federal Trade Commission's (FTC) comprehensive ban on noncompete agreements, declaring it an overreach of statutory authority and describing the ban as "arbitrary and capricious." This decision follows mixed district court opinions, suggesting a potential escalation to appellate courts and possibly the U.S. Supreme Court. The ruling reflects a significant divergence from another federal court in Pennsylvania, which upheld the FTC's authority, indicating a growing judicial disagreement over the regulation of noncompete clauses.

2. Reaction from Business and Legal Sectors: The ruling has elicited strong reactions from various sectors. The U.S. Chamber of Commerce and other plaintiff groups view the decision as a victory against governmental overreach, emphasizing the importance of maintaining competitive practices within American businesses and industries. Conversely, the FTC expressed disappointment, signaling a possible appeal and affirming their intent to continue scrutinizing noncompete agreements through individual enforcement actions. This reflects broader debates about the balance between protecting workers and fostering business innovation and competition.

3. Impact on Healthcare and Broader Economic Predictions: Within the healthcare sector, entities like the American Hospital Association have welcomed the ruling, citing concerns about the disruptive impact of the FTC's rule on hospital operations and patient care. On the economic front, the FTC had argued that eliminating noncompetes could enhance worker wages significantly, projecting an increase of $400 billion to $488 billion over a decade. However, Judge Brown criticized the rule for its lack of solid evidence and failure to consider the potential benefits of noncompete agreements, suggesting an underestimation of their role in fostering business stability and growth.

Lawmakers ask DOL about 'self-dealing' health plan service providers

By Allison Bell - The same kinds of fiduciary obligation fights hitting retirement plans may now be coming to health and welfare plan administrators and other service providers. Read Full Article…

HVBA Article Summary

1. Fiduciary Responsibilities and Compliance: House Democrats, including Rep. Robert Scott and Rep. Mark DeSaulnier, have requested that Lisa Gomez, Assistant Labor Secretary, discuss the enforcement of fiduciary obligations by health and welfare plan service providers under the Employee Retirement Income Security Act (ERISA). They are seeking clarification on how the Employee Benefits Security Administration (EBSA) ensures these providers adhere to their fiduciary duties, which are crucial for protecting the interests of plan participants.

2. Enforcement of Transparency Provisions: The lawmakers are also probing into EBSA’s strategies for implementing the new compensation disclosure requirements for benefit plan service providers, introduced in the Consolidated Appropriations Act (CAA), 2021. These requirements aim to enhance transparency around the costs associated with health plans and are particularly focused on entities like pharmacy benefit managers and third-party administrators, who play significant roles in managing these plans.

3. Resource Requirements for Effective Enforcement: Additionally, the letter questions what kinds of resources Congress should provide to enable EBSA to effectively oversee and ensure compliance with the transparency provisions of the CAA, 2021. This inquiry underscores the legislative intent to support regulatory bodies in upholding the law and safeguarding consumer rights in the health benefits landscape.

BCBS Minnesota must face ERISA lawsuit from Labor Department, judge rules

By Jakob Emerson - A federal judge has ruled that Blue Cross and Blue Shield of Minnesota must face a lawsuit from the U.S. Labor Department accusing the payer of incorrectly imposing a state provider tax on self-funded health plan customers and violating its fiduciary duties under ERISA. Read Full Article…

HVBA Article Summary

1. Background and Legal Basis: Since 1994, Minnesota has implemented a tax on the gross revenues of hospitals and other healthcare providers, which is aimed at funding the MinnesotaCare program for low-income residents. In a lawsuit filed in January, the U.S. Department of Labor accuses Blue Cross Blue Shield of Minnesota (BCBSM) of improperly passing this tax cost onto self-funded employer health plans, which was not authorized by the plans' governing documents.

2. Allegations and Financial Impact: The lawsuit alleges that between 2016 and 2020, BCBSM wrongfully collected approximately $66.8 million from these plans for the MinnesotaCare provider tax. This action was taken despite the providers not billing or transferring these tax costs to the plans, representing a significant financial imposition on these self-funded plans without their consent.

3. Judicial Ruling and Defense: U.S. District Judge John Tunheim recently denied BCBSM's motion to dismiss, affirming that the Labor Department has standing to pursue claims based on the alleged unauthorized tax collections. While BCBSM denies the claims and maintains that its payment rates, inclusive of all taxes and fees, are lawful and transparent, the case is set to proceed, highlighting the legal complexities surrounding provider taxes and third-party payer arrangements in healthcare financing.

GLP-1s Can Improve Many Common Health Issues, but They’re Not Magic

By Tim Church - GLP-1-based agonists (GLP-1s) are transforming the obesity treatment landscape and the positive results keep rolling in. In the last 12 months, there’s been a series of high-profile papers and clinical trials which have demonstrated GLP-1s to prevent or reverse prevalent chronic conditions such as sleep apnea, fatty liver, and CVD. Read Full Article…

HVBA Article Summary

1. Expanding Cardiovascular Treatment: Recent research has highlighted GLP-1s as promising agents in the battle against heart disease. The SELECT trial revealed that semaglutide can reduce major cardiovascular events by 20%, leading to its inclusion in Medicare and certain healthcare plans for patients at risk of heart disease who are overweight or obese. This sets a precedent for broadening FDA-approved uses of GLP-1s beyond weight management, potentially revolutionizing cardiovascular treatment strategies.

2. Liver Health and Metabolic Syndrome: GLP-1s have shown potential in addressing non-alcoholic fatty liver disease (NAFLD), a prevalent condition linked with obesity and diabetes. Research indicates these medications not only help reverse fatty liver but also improve related metabolic factors like cholesterol and blood sugar levels. This dual benefit could lead to FDA approval for GLP-1s in treating liver health, thus offering a multifaceted approach to managing metabolic syndromes.

3. Sleep Apnea and Workplace Productivity: Tirzepatide, a GLP-1/GIP receptor agonist, has demonstrated significant effectiveness in reducing sleep apnea events by up to 63%. This finding is particularly relevant given the widespread prevalence of obstructive sleep apnea (OSA) and its association with several chronic conditions. By potentially expanding FDA indications to include sleep apnea treatment, GLP-1s could not only improve individual health outcomes but also enhance overall workplace productivity and reduce healthcare costs related to chronic sleep deprivation and its comorbidities.

How long you might live based on where you're born, mapped

By Alex Fitzpatrick - There's as much as a nearly 10-year difference in life expectancy between U.S. states, a new report finds. Read Full Article…

HVBA Article Summary

1. Regional Differences in Life Expectancy: According to a recent CDC analysis, life expectancy at birth varies significantly across the United States as of 2021. States like Hawaii (79.9 years), Massachusetts (79.6 years), and Connecticut (79.2 years) boast the longest life expectancies, while Mississippi (70.9 years), West Virginia (71.0 years), and Alabama (72.0 years) report the shortest. These discrepancies highlight underlying regional health disparities and socio-economic factors influencing longevity.

2. Gender Disparities in Longevity: The CDC report also sheds light on the persistent gender gap in life expectancy across the country, with women generally outliving men. This gap ranges from 3.9 years in Utah to 7.6 years in New Mexico, suggesting that lifestyle, healthcare access, and possibly genetic factors contribute to differing longevity between genders.

3. Impact of Pandemics and Public Health Issues: The analysis indicates that the national life expectancy fell by 0.6 years from 2020 to 2021, primarily due to the COVID-19 pandemic and rising drug overdose rates. However, with the worst impacts of the pandemic receding and early data hinting at recovery, future reports might show improvements in life expectancy. Nonetheless, the ongoing challenges posed by COVID-19 and drug-related issues continue to pose significant public health threats.

10 states tackling prior authorization

By Claire Wallace - Since January, 10 states have passed laws reforming prior authorization rules in an effort to reduce care delays and save time for physicians and patients, according to an Aug. 19 report from the American Medical Association. Read Full Article…

HVBA Article Summary

1. Legislative Trends Across the States: In 2024, a wave of states including Vermont, Minnesota, Wyoming, Colorado, Illinois, Mississippi, Maine, Maryland, Oklahoma, and Virginia passed prior authorization legislation to streamline healthcare procedures and reduce administrative burdens. These reforms aim to enhance patient care efficiency by modifying response times and transparency requirements. Massachusetts is also considering additional reform bills that could be enacted by the end of the year.

2. State-Specific Innovations:

   • Minnesota has built on its 2020 prior authorization reforms by enacting laws in 2024 that eliminate prior authorization requirements for non-medication aspects of cancer and mental health care.

   • Vermont introduced a bill protecting patients with chronic conditions from repetitive prior authorization processes for unchanged treatments, ensuring urgent requests are addressed within 24 hours, and mandating that new insurers accept previous health plans' prior authorizations for up to 90 days.

   • Wyoming implemented a "gold card" program that exempts physicians with a consistent approval record from prior authorization and extends the validity of authorizations for chronic conditions.

3. Impact and Implications for Healthcare: These legislative measures across various states reflect a growing commitment to reducing the hurdles in patient care caused by prior authorization processes. By improving response times and increasing transparency, these laws are poised to significantly impact the efficiency of healthcare delivery and patient satisfaction, setting a precedent for nationwide healthcare reform.

Employers are worried about GLP-1s — most cover them anyway

By Rylee Wilson - Two-thirds of employers surveyed by the Business Group on Health cover GLP-1 drugs to treat obesity. The Business Group on Health, which represents large employers, published its annual survey of employers Aug. 20. The survey included 125 large businesses with a total of 17.1 million employees. Read Full Article…

HVBA Article Summary

1. Projected Increase in Healthcare Costs: In 2025, healthcare costs for employers are expected to rise by 7.8%, marking the highest increase in a decade. This surge is primarily driven by escalating pharmacy spending, with the Business Group on Health identifying it as the principal factor behind the cost escalation.

2. Employer Concerns Over Weight Loss Drugs: Many employers express significant concern regarding the appropriate usage and long-term expenses associated with GLP-1 and other new weight loss medications. Approximately 20% of employers are prepared to "implement immediately" policies to limit or reduce coverage for these drugs, while another 30% are strongly considering such measures. Drugs like Wegovy, Saxenda, and Zepbound, which can cost over $1,000 per month, are at the center of these concerns.

3. Evolving Coverage Decisions for GLP-1 Drugs: While a majority (67%) of employers provided coverage for GLP-1 drugs to treat obesity in 2024, a dynamic shift in coverage policies is evident. Blue Cross Blue Shield of Michigan, for instance, decided to stop covering these drugs for obesity in its fully insured commercial plans due to high costs. However, 3% of employers plan to add such coverage in 2025, and 13% are considering doing so in 2026 or 2027. Conversely, a near-universal 97% of employers continue to cover GLP-1 drugs for diabetes treatment.

Reimagining employee benefits to meet evolving needs and demands

By Kenneth Araullo - As 2024 progresses, significant shifts in the employee benefits landscape are emerging, according to insights shared by Drew Engebrecht (pictured upp r right), senior vice president – team lead, employee benefits at Holmes Murphy. Read Full Article…

HVBA Article Summary

1. Shift Toward Mental Health Focus: Engebrecht highlights a significant change in employee benefits, with a growing emphasis on mental health alongside physical health. This includes the implementation of comprehensive mental health programs, such as enhanced employee assistance programs, $0 copays for mental health services, and initiatives aimed at stress reduction and mindfulness.

2. Financial Wellness Programs: A rising trend identified by Engebrecht is the focus on financial wellness, driven by data showing that financial concerns are the top stressor for 57% of employees. Employers are increasingly offering resources like financial literacy education, budgeting tools, and student loan repayment management to help employees manage their financial health, reflecting a holistic approach to employee benefits.

3. Utilization of Data and Analytics in Tailoring Benefits: Advancements in technology are enabling more personalized employee benefits. Engebrecht points out that using data analytics helps organizations customize their benefits offerings to meet individual employee needs more effectively, enhancing satisfaction and engagement. This trend is supported by investments in robust benefits administration platforms that streamline processes and improve access to benefit information.

4 updates on Mounjaro, Ozempic

By Paige Twenter - In a phase 3 trial spanning three years, weekly injections of tirzepatide reduced the risk of Type 2 diabetes by 94%, Eli Lilly said Aug. 20. Tirzepatide, the active ingredient of diabetes drug Mounjaro and weight loss medication Zepbound, also led to an average weight loss of 22.9%. Read Full Article…

HVBA Article Summary

1. Long-term Study and Mechanism of Action: About 1,030 adults with prediabetes or those who are obese or overweight participated in a 176-week study of Mounjaro, a therapy noted for its safety and tolerability consistent with prior research. Mounjaro and Zepbound are categorized as glucagon-like peptide-1 receptor agonists (GLP-1) and glucose-dependent insulinotropic polypeptides (GIP), indicating their potential in impacting the increasing prevalence of Type 2 diabetes.

2. Market Trends and Safety Concerns: The popularity of GLP-1 medications is growing despite significant safety concerns and cost issues. Instances of patients attempting to stretch their medication by breaking open GLP-1 pens have been reported, which is strongly advised against by healthcare professionals. Additionally, there's an increase in use of compounded GLP-1 formulations, which has led to hospitalizations due to dosing errors, prompting an FDA warning.

3. Adherence and Economic Impact: Adherence to GLP-1 treatments like Wegovy is reportedly low, with an average duration of use around six months, primarily due to supply constraints. The study by Truveta also highlighted that discontinuation rates are notably high, influenced by factors like higher weight loss achievements, higher income levels, and absence of side effects. This reflects broader economic and racial disparities in access to these treatments.