UnitedHealth probe extends to Optum

By Chris Strohm and John Tozzi – The US Justice Department’s criminal division is digging into UnitedHealth Group Inc.’s prescription management services as well as how it reimburses its own doctors under an ongoing probe into the firm’s operations, according to people familiar with the matter. The previously unreported areas of the probe show the scrutiny is broader than was known and goes beyond an inquiry into possible Medicare fraud. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Justice Department Investigations Across Multiple Areas: UnitedHealth Group is currently the subject of multiple ongoing investigations by the U.S. Department of Justice (DOJ), covering areas such as its pharmacy benefit manager Optum Rx and its Medicare Advantage billing practices. These include both civil and criminal probes. Although no formal charges have been filed and no executives have been accused of wrongdoing, the breadth of the scrutiny adds potential legal and reputational complexity for the company.

2. Company Response and Market Reaction: UnitedHealth has stated that it has “full confidence” in the integrity of its business practices, referencing prior favorable audits and legal developments, such as a court-appointed special master finding no evidence to support a $2 billion Medicare overbilling claim. Market response to the news has been mixed: while the stock initially dropped on the news of the probe, it has partially rebounded, aided by investor confidence following Berkshire Hathaway’s purchase of 5 million shares.

3. Leadership Changes and Oversight Measures: Amid the investigations and a challenging year marked by a missed earnings forecast and the abrupt resignation of CEO Andrew Witty, UnitedHealth has undertaken significant leadership changes. Former CEO Stephen Hemsley has returned to stabilize the company and improve transparency. As part of this effort, the company has also established a “public responsibility committee” on its board to strengthen oversight of regulatory and reputational risks, especially concerning pharmacy benefits management practices, which have come under increased regulatory attention.

Life insurance report suggests need for better education

By Bruce Shutan – Appreciation for the value of life insurance has grown since the pandemic. However, new LIMRA research suggests an uphill educational climb for benefit brokers and their employer clients just ahead of Life Insurance Awareness Month in September and open enrollment. Among the key findings supporting this conclusion: 57% of those who only have life insurance through their employer believe they have enough coverage, which doesn't square with reality. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Coverage Gaps Could Leave Families Vulnerable: According to LIMRA's 2025 Insurance Barometer Study, nearly half of households relying solely on workplace life insurance say their families would face financial difficulty within six months if the primary wage earner were to die unexpectedly. This suggests that the median employer-provided coverage — typically a flat $20,000 or one times salary — is insufficient for long-term financial protection, falling short of what experts recommend.

2. Widespread Confusion and Underreporting: The study found a major disconnect between actual coverage and employee awareness: while at least 39% of adults have workplace life insurance, only 29% reported having it. Furthermore, more than one-third of workers don’t even know if they have access to this benefit, and among those who do, only 57% feel they understand their life insurance coverage well, pointing to a serious communication and education gap.

3. Employees Want More Communication, Not Just During Enrollment: Half of surveyed workers said their employer only shares benefits information during open enrollment, but a significant 73% prefer receiving updates more frequently, either a few times or regularly throughout the year. The data also show that younger employees are especially eager for ongoing communication, reflecting a generational shift toward more proactive and transparent benefits engagement.

The ACA Subsidy Expiration Will Hit Millions Hard

By Joey Rettino – When Congress passed pandemic-era enhancements to Affordable Care Act (ACA) premium subsidies in 2021, it wasn’t just a policy tweak — it was a lifeline. But unless lawmakers act, those subsidies will vanish on January 1, 2026. According to KFF, the average ACA enrollee could see premiums spike 75% overnight. For many, that will mean a choice between things like their health coverage and rent or food. The Congressional Budget Office estimates more than 4.2 million people could lose coverage over the next decade as a result. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Impact on Affordability and Coverage: If ACA subsidies expire, premiums are projected to rise sharply for groups such as young adults aging off their parents’ plans, older adults under 65 who are not yet eligible for Medicare, and small business owners. Without affordable options, many may opt out of coverage entirely, increasing the number of uninsured and leaving families more vulnerable to medical debt and financial instability.

2. Economic and Community Effects: Entrepreneurs, gig workers, and small-business owners who depend on ACA marketplaces for health insurance could face monthly premium hikes of hundreds of dollars. This may force some to abandon independent work, close businesses, or shift to large employers offering subsidized coverage. At the community level, rural hospitals and state health systems already under stress could face additional burdens from more uninsured patients seeking costly emergency care instead of preventive treatment.

3. Market Consolidation Risks: Regional and nonprofit insurers that provide alternatives to the major national carriers could see enrollment declines severe enough to push them out of ACA marketplaces. If these smaller plans disappear, consumer choice would shrink, leaving people increasingly dependent on the “Big 7” insurers. These larger companies may either consolidate their dominance by acquiring competitors or exit the marketplaces if risk pools become older and sicker, raising the possibility of reduced competition and unstable insurance markets.

UPDATED: Trump locks in 15% pharmaceutical tariff rate for EU, while generic drugs get a pass

By Fraiser Kansteiner – A little less than a month after the reveal of a wide-ranging trade deal between the United States and the European Union, the White House has shed more light on how it plans to tax pharmaceuticals and other products coming over from the bloc. Starting Sept. 1, the U.S. will impose a “Most Favored Nation” (MFN) tariff rate on generic pharmaceuticals sourced from the EU, including their ingredients and chemical precursors, according to a White House fact sheet issued Thursday. Read Full Article...

HVBA Article Summary

1. Tariff Framework Clarified: The U.S. has reaffirmed a 15% base tariff on most branded pharmaceuticals imported from Europe, while maintaining that some undisclosed MFN (most-favored-nation) rates will be “effectively zero or close to zero.” This update, released by the European Commission, clarifies earlier confusion about whether Section 232 national security tariffs might raise the baseline. The new framework suggests that Europe’s pharmaceutical industry—valued at over €300 billion annually—will avoid the steep sectoral tariffs of 150% to 250% that President Trump has hinted at for other trading partners.

2. Mixed Industry Reactions: Responses to the announcement have diverged. Some U.S. advisors, such as KPMG’s Kristin Pothier, note the 15% cap gives branded drugmakers more certainty in planning supply chains and tax strategies. However, the European Federation of Pharmaceutical Industries and Associations (EFPIA) strongly criticized the move, stating it “breaks a 30-year commitment” to keep tariffs off innovative medicines. EFPIA warned that without exemptions or long-term assurances, patients could face higher costs and reduced access, raising broader concerns over future trade and pricing stability.

3. Impact on Generics Remains Uncertain: The generics market, which accounts for 91% of prescriptions in the U.S., faces greater vulnerability. According to the U.S. Pharmacopeia, 35% of generic active pharmaceutical ingredients (APIs) are sourced from India, 18% from Europe, and only 12% from domestic U.S. production. Industry experts, including USP CEO Ronald Piervincenzi, caution that generic drugmakers have “little resilience” against tariff shocks compared to large innovative drugmakers. This uncertainty has pushed generic manufacturers like Aurobindo, Celltrion, and Hikma to announce U.S. investments ranging from $250 million to $1 billion to strengthen their local presence and hedge against future trade disruptions.

Benefits Think: Healthcare's shift to sound cybersecurity measures

By Zach Evans - Health insurance payers, healthcare providers and their associated contractors who handle patient data have all been forced to reckon with heightened cybersecurity concerns. For the entire industry, including HR and benefit professionals who witness these data breaches firsthand, a proactive rather than reactive approach is more important than ever. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Healthcare Cyberattacks Are Intensifying and Underreported: The number of cyber threats targeting healthcare is growing rapidly, with 67% of healthcare organizations experiencing ransomware attacks in 2024 — nearly double the 2021 figure. Most threats are never publicly disclosed, as AI systems triage and suppress non-urgent alerts. Despite this, the underlying risk is escalating as attackers become more sophisticated and persistent.

2. Massive Financial and Operational Consequences: High-profile breaches, like the Change Healthcare ransomware attack, can cost billions and impact millions of individuals. This incident alone may cost over $2.3 billion and has triggered government investigations and broader industry scrutiny. The scale of such incidents is driving major investments in cybersecurity, exemplified by Google’s planned $32 billion acquisition of the cloud security firm Wiz.

3. Proactive, AI-Driven Cybersecurity is Crucial: Traditional reactive defenses are overwhelmed by the sheer volume of alerts. The healthcare sector must adopt proactive strategies that prioritize critical vulnerabilities using AI tools. These systems not only filter noise but can also predict attack paths and prevent repeat intrusions — a vital approach as industry consolidation increases the potential fallout from successful breaches.

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: In 2024, West Virginia regulators imposed a total of $493,000 in fines on several Pharmacy Benefit Managers (PBMs) for various compliance issues. The largest penalties, amounting to $1.4 million, were levied on two affiliates of CVS Health—Caremark and CaremarkPCS Health—under an amended order. Other PBMs fined include Express Scripts ($160,000), Rightway ($66,000), WellDyne ($64,000), and Pharmacy Benefit Dimensions ($32,750).

2. Dispute and Settlement Between Caremark and Regulators: CVS Caremark responded to the fines by highlighting a disagreement with the West Virginia Insurance Commissioner regarding interpretations of regulatory requirements, specifically around pharmacy audit procedures and reimbursement practices. This regulatory conflict was resolved through a collaborative settlement, and a state court has dismissed Caremark’s appeal. However, a formal order reflecting the terms of the settlement is still pending issuance.

3. Context of Healthcare Challenges in West Virginia: These regulatory actions occur within a broader context of healthcare difficulties in West Virginia, a state grappling with high levels of economic hardship, chronic health issues, and limited access to pharmacy services. According to a recent study published in JAMA Network Open, about 30% of West Virginia residents live in areas classified as “pharmacy deserts,” making timely access to medications a significant challenge.

FDA Clears OTC Glucose Monitoring System for Weight Management

By Stephanie Brown – The U.S. Food and Drug Administration has cleared the Signos Glucose Monitoring System, an over-the-counter glucose monitoring system for weight management. Signos integrates the Stelo by Dexcom glucose biosensor with an artificial intelligence-driven platform to show how food, activity, stress, sleep, and timing affect the body in real time -- empowering people to make personalized, biology-backed health decisions. Read Full Article...

HVBA Article Summary

1. Personalized Health Insights via Glucose Monitoring: Signos offers a health monitoring system that leverages continuous glucose data and artificial intelligence to deliver individualized metabolic guidance. By translating real-time glucose fluctuations into simple, personalized recommendations, the system helps users develop healthier daily habits tied to sleep, exercise, stress, and meals—all with the goal of managing weight and lowering the risk of chronic diseases.

2. Subscription-Based Service Model: The service is available through a subscription plan, with pricing set at $139 per month for a three-month commitment or $129 per month for a six-month plan. Each plan includes access to continuous glucose monitors (CGMs) provided by the company, eliminating the need for customers to source additional equipment.

3. Market Context and Health Mission: Amid growing concerns over metabolic health—highlighted by rising obesity rates and projections that diabetes will affect 1.3 billion people by 2050—Signos positions its offering as part of a larger mission to improve public health. The company emphasizes its commitment to empowering individuals with real-time, data-driven insights that support long-term health, vitality, and self-management.