Trump seeks to lower drug costs for U.S. employers to European prices

By Allison Bell - Employer health plan sponsors and their groups are waiting to see whether, and how, a big new prescription drug cost control effort by the White House might affect them. President Donald Trump added flames to the prescription drug fight fire last week by sending letters to the chief executive officers of 17 big pharmaceutical companies. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. President Trump's Push for Drug Pricing Reform: President Trump has called on 17 pharmaceutical company CEOs to adopt "most-favored nation" (MFN) pricing across Medicaid, Medicare, and commercial health plans. This policy would require drug prices in the U.S. to be no higher than the lowest prices paid in other wealthy countries such as Canada, Europe, and Japan—aiming to lower costs for American consumers and health programs.

2. Mixed Reactions to the MFN Strategy: The MFN approach has drawn both support and criticism. Supporters argue that the U.S. bears too much of the burden for global pharmaceutical R&D and that a rebalancing is necessary. Critics, including industry groups and health policy analysts, warn that enforcing international price benchmarks could reduce innovation, delay access to new drugs, and sharply decrease investment in U.S.-based clinical trials.

3. Implications for Innovation and Alternative Approaches: If enacted, MFN pricing may reduce drug costs in the short term but could also limit the development of future treatments, affecting care for diseases like cancer, Alzheimer’s, and chronic conditions. Some experts propose alternative reforms, such as increasing public or nonprofit investment in drug research, to ease global pricing inequities without discouraging innovation in the U.S. pharmaceutical industry.

Insurance Companies’ Medicare Pullback Is Here

By David Warner - Many seniors enjoy the perks that come with Medicare Advantage. But those extras—like dental coverage and free gym memberships—are being scaled back. Insurers are cutting benefits and exiting from unprofitable markets, and Wall Street is cheering them on. Once rewarded by investors for rapid expansion in the lucrative privatized Medicare program, companies are now being applauded for showing restraint amid rising medical costs and lower government payments. Read Full Article… 

HVBA Article Summary

1. Medicare Advantage Strategy Shift: Major insurers such as CVS Health and Humana are deliberately scaling back their Medicare Advantage offerings to restore profitability after experiencing steep losses from unexpectedly high medical costs. UnitedHealth, which had pursued more aggressive growth, is now also planning a significant reduction in its Medicare Advantage presence by 2026 as part of a broader strategic shift.

2. Industry-Wide Retrenchment: The pullback from Medicare Advantage is not isolated—similar reductions are taking place across Medicaid and ACA exchange plans. These moves reflect a growing industry realization that long-term profitability in government-sponsored programs now requires tighter cost controls, more conservative growth strategies, and a reevaluation of overly generous plan designs.

3. Market Outlook and Investor Sentiment: Despite recent cutbacks, major insurers remain committed to Medicare Advantage, and the market still offers broad plan choices for consumers. However, investor confidence has shifted toward companies that demonstrate disciplined financial management and margin improvement, signaling that measured, risk-aware growth is now more highly valued than rapid expansion.

Renewal season is coming: Help clients listen, learn and lead

By Chelsea Ryckis - With renewal season fast approaching, now is the perfect time for benefits advisors to guide employer clients in surveying their employees not just to check a box, but to build strategic benefits programs that reflect real employee needs. Too often, employers assume they know what their people want. But the data tells another story. According to Aflac, while 80% of employers think employees are satisfied with their benefits, only 58% of employees say the same. That’s not just a disconnect, it’s a strategic vulnerability. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Use Strategic Benefits Surveys to Uncover Value and Gaps: Encourage clients to conduct concise (5–10 minute), anonymous, and actionable benefits surveys that go beyond surface-level feedback. These surveys should explore what employees truly value, where current offerings fall short, and which emerging needs (like mental health support or flexible work) are top of mind. Since benefits typically make up 30–40% of total compensation, it’s critical to ensure that investment aligns with employee preferences.

2. Turn Feedback into Action to Strengthen Trust and Retention: It’s not enough to collect data—clients must act on it. Without follow-through, surveys can backfire and damage employee trust. Following the model Survey → Analyze → Act → Communicate helps ensure feedback leads to real improvements. This is essential, as 60% of employees say benefits are a major factor in whether they stay or leave a job (Forbes), and those who are highly satisfied with their benefits report higher job satisfaction and productivity (EBRI).

3. Lead as a Strategic Advisor, Not Just a Benefits Vendor: Advisors have a key role in guiding clients from data collection to implementation. This includes analyzing trends, segmenting insights (e.g., by age or job role), and building a phased strategy: quick wins, mid-term tweaks, and long-term initiatives. Communicating changes clearly and consistently to employees closes the feedback loop and builds credibility. By doing so, you reinforce your value as a trusted partner during renewal season, helping clients drive satisfaction, retention, and ROI.

New report reveals employees are underprepared for retirement and healthcare costs

By Alyssa Place - The gap between employees' emotional optimism about retirement and their actual financial readiness is proving to be a challenging one to close. A quarterly report from IRALOGIX highlights a growing disconnect and dissatisfaction around financial well-being and economic stability: 43% of Americans report declining confidence in the economy and 71% fear inflation will erode their savings. However, few are taking concrete steps or precautions to strengthen their financial future. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Americans Lack Financial Readiness for Retirement, Especially in Healthcare: While many Americans feel emotionally ready for retirement, they are falling short financially — particularly when it comes to healthcare planning. Readiness in this area has dropped to 36.7%, with most people lacking strategies to manage long-term care, surprise medical bills, or chronic illness costs. Low confidence in Medicare's future adds to the risk of financial instability in retirement.

2. Inflation and Policy Uncertainty Undermine Confidence and Savings Efforts: Rising inflation, Social Security concerns, and ongoing market and policy volatility are weakening Americans’ economic confidence, which has dropped to 42.0% in the index. Although tools like IRAs and automatic contributions are available, many people aren’t using them effectively. Additionally, inflation is making it more difficult for workers to boost savings, even when they have the intention to do so.

3. Employers Play a Crucial Role in Bridging the Retirement Readiness Gap: Employers have a major opportunity to support financial wellness by offering access to certified financial planners, improving benefits education, and encouraging the use of savings tools like HSAs, automatic escalation, and catch-up contributions. These steps can help employees turn concern into action and move from short-term uncertainty to long-term retirement security.

New AMA Report Highlights Lack of Competition in PBM Market

By Marissa Plescia - A new analysis from the American Medical Association (AMA) adds to the growing evidence detailing the lack of competition and high vertical integration in the pharmacy benefit manager market. The paper is based on 2022 and 2023 data on prescription drug plan enrollees and comes shortly after the Federal Trade Commission and the U.S. House Committee on Oversight and Accountability released similar reports on PBMs. Read Full Article…

HVBA Article Summary

1. Market Concentration and Vertical Integration: In 2023, the four largest pharmacy benefit managers (PBMs)—OptumRx, CVS Caremark, Express Scripts, and Prime Therapeutics—controlled 67% of the national PBM market. Additionally, 77% of prescription drug plan enrollees were in vertically integrated plans, where the PBM and insurer were owned by the same company, indicating significant consolidation in the industry.

2. Shared Ownership Between PBMs and Insurers: Nine of the ten largest PBMs, including OptumRx (UnitedHealth), CVS Caremark (CVS Health), and Express Scripts (Cigna), were owned by major health insurers. This vertical integration raises concerns about conflicts of interest and market dominance by a few large entities.

3. Policy and Regulatory Concerns: The AMA highlighted the lack of transparency and accountability in PBM operations as contributing to higher drug prices and potential harm to patients. In response, lawmakers have introduced bipartisan bills like the PBM Reform Act and the Patients Before Monopolies Act, aimed at banning spread pricing and preventing PBMs from owning pharmacies, respectively.

Cancer in the workplace: What we've learned about supporting a younger, at-risk workforce

By Christopher Smith and Josh Sturm - Cancer is no longer something we, as employers, can afford to treat as a rare occurrence in our workforce. It’s here. Rates are rising—especially among people under 50—and it’s hitting closer to home than many of us anticipated. We’ve both seen firsthand the impact cancer can have on employees’ lives—physically, emotionally, and financially. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Younger Workforce, Rising Cancer Risk: Cancer diagnoses are increasingly affecting younger, working-age adults in their 30s and 40s, particularly with screenable and treatable types like breast, cervical, colorectal, and prostate cancer. Recognizing this shift, Universal Music Group (UMG) revamped its benefits approach to focus on early detection and risk stratification. Within the first year of launching their new cancer program, 20–30% of eligible employees enrolled, and 56% of those identified as needing one or more screenings completed at least one, demonstrating strong engagement among this critical demographic.

2. Convenient, Digital-First Cancer Care: Today’s workforce—especially Gen X and millennials—demands healthcare that is fast, accessible, and fits seamlessly into busy, tech-driven lives. UMG’s partnership with Color Health introduced virtual consultations and at-home testing, removing barriers like scheduling delays and travel. This approach led to a 77% increase in screening adherence, with the median age of enrollees just under 40. Notably, 62% of participants were assigned female at birth, and 18% identified as Hispanic or Latino, indicating that digital-first models can also advance equity and reach underserved groups.

3. Whole-Family Support and Mental Health Inclusion: Cancer impacts not only those diagnosed but also their families and caregivers—who are often left unsupported. Caregivers face serious mental health risks, being 46% more likely to suffer from severe depression and 53% more likely to experience anxiety. UMG’s program addresses this by including caregivers and dependents in its services: nearly 10% of enrollees are caregivers or survivors, and an additional 10% are dependents. This whole-family approach, coupled with trust-building tools like 24/7 microsite access and direct lines of communication, ensures employees feel supported during one of life’s most difficult challenges.

Will AI replace healthcare jobs?

By Giles Bruce - Leaders from companies such as Amazon, Ford and JPMorgan Chase have predicted that AI will replace a slew of jobs in the future. But will that hold true in healthcare as well? Health system leaders told Becker’s that AI has the potential to supplant administrative roles but will only enhance the work that clinicians do. Read Full Article…

HVBA Article Summary

1. AI Integration in Healthcare Operations: AI is already embedded across various healthcare functions, particularly in administrative and repetitive areas like medical coding, documentation, billing, scheduling, and call centers. These implementations are streamlining workflows, accelerating diagnoses, and automating tasks that traditionally required human input.

2. Human-AI Collaboration Over Replacement: While AI has the potential to replace certain back-office roles, healthcare leaders emphasize its current role as a supportive tool. It enhances efficiency, reduces clinician burnout, and enables providers to concentrate on high-value work such as patient care, empathy, and complex clinical decisions.

3. Evolving Workforce and Ethical Implementation: The rise of AI is reshaping the healthcare value chain by shifting human roles toward more strategic, non-repetitive functions. Experts stress the importance of upskilling, ethical AI deployment, and ensuring equitable access—especially in rural and underserved areas—so that both staff and patients benefit from technological advances.