House Republican revamps health care package effort

By Allison Bell – A House Republican has introduced a new, expanded version of his Great American Healthcare proposal. Rep. Eric Burlison, R-Mo., filed a Great American Healthcare Act bill earlier this week. The bill is similar to the Great American Healthcare Plan bill that Burlison introduced in April. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Expanded HSA and HRA Flexibility: The updated proposal includes multiple provisions aimed at making health savings accounts (HSAs) and health reimbursement arrangements (HRAs) more accessible and versatile. One section would grant HSAs the same bankruptcy protections currently available to retirement accounts. Another would allow large employers to meet Affordable Care Act coverage requirements by contributing to employees’ HSAs. The bill also permits taxpayers to use up to $5,000 from an HSA to open a child’s Trump account and allows remaining HSA funds to be rolled into a Trump account upon the account holder’s death.

2. New Health Care Price Transparency Requirements: The legislation introduces additional disclosure obligations for medical labs, imaging providers and health plan network administrators. These transparency provisions would require clearer reporting of compensation arrangements and service pricing structures. The effort aligns with broader bipartisan activity in both chambers of Congress focused on health care price transparency. Lawmakers may be seeking to build on momentum from recent committee actions advancing related bills.

3. Broader Policy Scope and Legislative Strategy: Beyond health accounts and transparency, the bill would modify how Federal Reserve banks pay interest on reserves held by depository institutions. The inclusion of financial system provisions broadens the package beyond traditional health policy. The proposal has received backing from the National Federation of Independent Business, suggesting support from small-business advocates. With a potential government funding deadline approaching, lawmakers may attempt to advance health provisions alongside a continuing resolution to keep the federal government operating.

Senate confirms Schwartz for CDC director

By Adriel Bettelheim and Maya Goldman – The Senate confirmed Erica Schwartz for Centers for Disease Control director on Wednesday, giving the beleaguered agency its first full-time political leader in almost a year. Read Full Article...

HVBA Article Summary

1. Narrow Senate Confirmation Reflects Partisan Divide: Schwartz was confirmed in a 51-44 vote, with support from all Republicans present and only one Democrat, Sen. Tim Kaine. Kaine said she was qualified for the role, despite broader Democratic opposition. The margin underscores the political sensitivity surrounding leadership of the CDC. Her confirmation fills a leadership vacuum but does not eliminate partisan tensions over the agency’s direction.

2. Concerns About Political Independence Persist: During her confirmation hearing, Schwartz faced pointed questions about whether she could resist political pressure from President Trump or Health Secretary Robert F. Kennedy Jr. She pledged to rebuild trust in the CDC but avoided directly committing to informing Congress if asked to implement unscientific or harmful policies. Some public health leaders withdrew their support after the hearing, citing a lack of clear answers. These concerns continue to shape perceptions of how independently she will lead the agency.

3. Leadership Instability and Broader HHS Dynamics: Schwartz is Trump’s third nominee to head the CDC, following the short-lived tenure of Susan Monarez, who said she was fired for resisting vaccine policy directives. The agency has operated without a full-time political leader for nearly a year and faces morale and staffing challenges. Meanwhile, another HHS nominee, Sean Kaufman, is awaiting a Senate vote amid scrutiny over past anti-vaccine statements. Together, these developments highlight ongoing turbulence within federal health leadership.

PBMs Keep Putting It in Writing: They Are Not the Fiduciary

By Jake Velie – The most important sentence in some PBM paperwork is not buried in the pricing exhibit. It is not in the rebate schedule. It is not in the reporting package. It is the disclaimer. Read Full Article...

HVBA Article Summary

1. PBMs Explicitly Disclaim Fiduciary Status: The article highlights contract language in which a PBM states it “is not acting as a fiduciary” under ERISA and cannot be named as one by the client. While PBMs handle claims adjudication, rebate negotiations, formulary management, and specialty pharmacy operations, they contractually distance themselves from fiduciary responsibility. This leaves the legal and compliance burden squarely on the employer as plan sponsor. The author argues that employers should treat these disclaimers as a clear signal to strengthen their own oversight processes.

2. Rising Specialty Drug Concentration Increases Employer Risk: Client reports reviewed by the author show specialty drugs accounted for 71.6% of total plan spend in 2025 and rose to 88.1% in the first quarter of 2026. Such concentration, he contends, represents financial and fiduciary risk for self-funded employers. Even when rebates are included in reporting, employers must still evaluate alternative channels, sites of care, and therapeutic options. Simply receiving utilization and rebate reports does not demonstrate that a plan sponsor pursued the lowest net cost available.

3. Transparency Alone Does Not Satisfy ERISA Duties: The article references disclosure requirements under the Consolidated Appropriations Act but emphasizes that transparency is only a starting point. Employers must be able to document that they evaluated lower-cost alternatives, including biosimilars, 340B pricing, manufacturer assistance programs, and site-of-care optimization. The author positions managed services support as a way to help employers document decision-making and demonstrate prudent oversight. Ultimately, he argues that fiduciary responsibility cannot be delegated away and must be actively managed by the plan sponsor.

Insurers propose a median ACA rate hike of 15% for 2027: KFF

By Paige Minemyer – Insurers' full slate of rate filings for the Affordable Care Act's exchanges are out, and the median requested premium increase is 15%, according to a new analysis. Researchers at KFF dug into filings from 276 insurers participating in the marketplaces in all 50 states and the District of Columbia. The proposed increase would represent the second straight year where the median premium hike was in the double-digits. Read Full Article...

HVBA Article Summary

1. Premium increases remain historically elevated: The proposed 2027 hike follows recent years of significant increases, though it is below the prior year's proposed and final median jumps. Even so, it would rank among the largest requests since 2018, after a period of relative stability in the individual market. If approved as filed, marketplace premiums would have climbed roughly one-third over a two-year span. The data signal sustained upward pressure rather than a short-term spike.

2. Wide variation in insurer requests: While many insurers are seeking mid-teen percentage increases, a substantial number are pursuing far steeper adjustments. More than 50 insurers requested hikes of 25% or higher, indicating that some markets or risk pools may be facing sharper cost pressures. At the same time, dozens of insurers proposed increases under 10%, underscoring geographic and company-level differences. The distribution of filings suggests uneven impacts for consumers depending on their plan and state.

3. Cost drivers extend beyond basic medical inflation: Insurers cite rising medical and pharmaceutical costs, including higher utilization and greater claims intensity, as key contributors to premium growth. Some filings point to broader economic factors such as supply chain pressures, labor shortages and inflation influencing provider pricing. Policy dynamics—including the expiration of enhanced premium tax credits, regulatory changes and the No Surprises Act’s dispute resolution process—are also factored into rate calculations. Together, these elements illustrate a complex mix of healthcare, economic and regulatory forces shaping 2027 premiums.

Health Plans Losing Court Battles in No Surprises Act Cases

By Joyce Frieden – The fate of the No Surprises Act's independent dispute resolution (IDR) clause continues to hang in the balance as it winds its way through the courts. The No Surprises Act, signed into law in 2020 by President Donald Trump, was intended to protect patients from unexpected bills for care from out-of-network providers and to ensure fair contracts between health plans and physicians. It requires health plans and providers to resolve their billing disputes by establishing an IDR arbitration process in which the insurer and the provider each come up with an offer and an independent third party chooses one of the two. Read Full Article...

HVBA Article Summary

1. Courts Are Shielding IDR Awards From Relitigation: A federal judge in Georgia dismissed Elevance’s lawsuit challenging thousands of arbitration outcomes, ruling that courts lack jurisdiction to revisit IDR decisions that Congress intended to keep out of extended litigation. The judge noted that Elevance lost 192 of 228 disputes initiated on a single day and referenced CMS data showing providers prevail in 85% of determinations. He suggested these outcomes alone do not prove fraud and indicated skepticism toward claims of a broad conspiracy. Elevance has said it plans to appeal the ruling.

2. Insurers and Providers Offer Competing Narratives of Abuse: America’s Health Insurance Plans argued that misuse of the IDR process is driving billions in excess spending and increasing healthcare costs, calling for policy changes. Physician groups, including the AMA and ACEP, have countered that insurers engage in problematic conduct such as reprocessing claims after losing and delaying or withholding payments. Survey data cited in the article found that 22% of IDR awards in 2023 and 11% in 2024 had not been paid to clinicians. Legal experts note that while awards are binding, providers face limits in enforcing payment through the courts.

3. IDR Volume Continues to Surge Despite Legal Battles: Federal data show that from January through May 2026, plans and providers filed 1.43 million IDR applications, a 46% increase over the same period in 2025. During those five months, 1.36 million cases were resolved, indicating agencies are struggling to keep pace. The Congressional Budget Office has reported that providers win roughly 80% of IDR cases and can secure payments up to five times the average contracted rate. Observers caution that high win rates alone do not establish wrongdoing, as they could reflect low insurer offers, problematic submissions, or both.

Novo Nordisk eyes bolt-on deals as pipeline disappointments pile up

By Elizabeth Cairns – “If you don’t like setbacks and you don’t like failure, don’t get into the pharma industry,” Novo Nordisk CEO Maziar Mike Doustdar said on a call with media Wednesday. The implication was unintended, but anyone who is into disappointment would find a lot to enjoy about Novo in recent months. Reporting its second-quarter results, the company disclosed a partial miss in a Phase 3 diabetes trial of its big hope CagriSema. It also said it ended work on an asset that it got when it bought Inversago Pharma, rendering that deal a dead loss. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Novo Nordisk Signals Greater Focus on External Innovation: Novo Nordisk executives said the company is actively evaluating external pipeline opportunities and sees bolt-on acquisitions as a way to strengthen its research portfolio following several recent clinical setbacks. Leadership emphasized that investors are focused on long-term innovation rather than whether new products originate internally or through acquisitions, provided deals are strategically and financially sound. The company also noted that expanding its pipeline is important to offset future patent expirations and maintain long-term growth.

2. Pipeline Setbacks Highlight R&D Challenges: Novo reported multiple recent development disappointments, including CagriSema underperforming Eli Lilly’s Mounjaro on blood sugar reduction in a head-to-head diabetes study despite delivering similar weight loss. The company also discontinued its obesity candidate monlunabant after weak clinical performance, resulting in a DKK 4 billion ($616 million) impairment charge, while the failed cardiovascular program ziltivekimab could lead to an additional write-down of up to DKK 4.6 billion ($709 million). Executives pointed to the success of acquired sickle cell therapy etavopivat as an example of how external acquisitions can complement internal research efforts.

3. Oral Wegovy Continues Strong Growth Despite Broader Challenges: Novo highlighted oral Wegovy as a major commercial success, reporting more than five million total prescriptions worldwide and approximately 265,000 weekly prescriptions as of mid-July. The company also said roughly 300,000 patients in the UK began using the oral therapy within three weeks of launch, while more than 90% of global prescriptions have come through self-pay channels. Executives indicated current pricing is intended to accelerate market adoption but acknowledged pricing strategies may evolve over time as the obesity treatment market develops.

Soaring medical costs force employers to tighten benefits

By Alan Goforth – Employer benefits are under more pressure and scrutiny than they have been in years. "Cost volatility, more complex workforce needs, tighter regulatory requirements and emerging technologies such as AI are pushing organizations beyond incremental adjustments toward more disciplined benefit management," according to the latest Benefits Benchmarks report from Gallagher. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Medical and pharmacy costs are driving tighter oversight: Employers are facing increasing uncertainty around health plan renewals due to elevated cost trends, claims volatility and growing exposure to specialty drugs and complex conditions. As a result, organizations are revisiting long-held assumptions and applying more disciplined management practices to their medical plans. Pharmacy benefits, in particular, are receiving closer scrutiny as specialty medications and GLP-1 drugs raise spending concerns. Employers are shifting from a more hands-off approach to active oversight of pricing transparency and vendor performance.

2. Voluntary benefits and wellbeing strategies are being restructured: Voluntary benefits are no longer treated as peripheral offerings but are being used strategically to address gaps in core coverage and affordability challenges. Employers are focusing on improving how these options are curated and communicated so workers can make more informed decisions. At the same time, wellbeing programs are evolving into integrated frameworks that connect health, financial security and engagement. Companies are simplifying access, consolidating vendors and aligning resources more closely with employee needs to improve effectiveness.

3. Absence management and compliance pressures are increasing complexity: Expanding leave requirements and shifting workforce expectations are adding operational and regulatory strain for employers. Organizations are placing greater emphasis on how leave policies interact and are executed, rather than simply expanding time-off offerings. Absence management is now viewed as a factor that directly affects productivity, compliance risk and employee trust. This shift underscores the broader priority of maintaining affordability and governance while keeping benefits practical and credible.