Biden administration ends birth control benefits mandate fight

By Allison Bell - The Biden administration is suspending an effort to limit which employers can cite objections to use of birth control as a reason not to provide birth control benefits.  Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Policy Evolution and Withdrawal: The Biden administration has announced the withdrawal of draft birth control benefits regulations introduced in February 2023. These proposed regulations aimed to modify the Affordable Care Act’s women's health services requirements, specifically by eliminating exemptions for employers with moral objections to birth control while maintaining exemptions for religious employers. The administration cited the need to focus on other priorities and to reevaluate the proposal in light of 44,825 public comments received.

2. Historical Context and Legal Challenges: The Affordable Care Act has required coverage of preventive health services, including birth control, without cost-sharing since 2010. However, the implementation has been fraught with legal and political challenges. The Obama administration's attempts to accommodate religious objections faced backlash and legal disputes, leading to a 2014 Supreme Court decision favoring for-profit employers' rights to exclude birth control coverage. The Trump administration later expanded exemptions in 2018, upheld by the Supreme Court in 2020.

3. Future Implications and Agency Responsibilities: Despite withdrawing the draft regulations, federal agencies affirmed their ongoing responsibility to administer the ACA's requirements for women’s preventive health services. The Treasury, HHS, and Labor Departments left the door open for future proposals, potentially revisiting similar regulatory changes in alignment with public feedback and legal obligations. This decision underscores the complex balance between regulatory enforcement, public health priorities, and accommodating diverse employer perspectives.

Lawmakers call for curbs on UnitedHealth’s growing empire

By Casey Ross, Bob Herman, Tara Bannow, and Lizzy Lawrence - Democratic lawmakers are calling for aggressive action to curb the increasing market power of UnitedHealth Group, including a possible breakup of a business empire they say is undermining competition, corrupting Medicare, and hurting vulnerable patients. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Call for Regulatory Action and Antitrust Measures: Lawmakers, including Sen. Elizabeth Warren and Rep. Pat Ryan, are demanding swift action to curb UnitedHealth Group's market dominance. They emphasize the urgent need for antitrust reforms to prohibit joint ownership of insurers and provider subsidiaries, citing anticompetitive practices that harm patients and independent medical groups. State-level initiatives, such as legislation to regulate corporate ownership of medical practices and ban restrictive employment agreements, are also being introduced.

2. Impact on Patients and Communities: UnitedHealth's consolidation of healthcare providers has led to disruptions in care, with reports of impaired access to medical services and questionable practices like inflated diagnoses to extract higher Medicare payments. Examples from Oregon and Connecticut highlight how corporate control of local healthcare networks has caused confusion, delayed care, and constrained patients’ choices. These issues have fueled public outrage and a loss of trust in the system.

3. Systemic Challenges and Bipartisan Hurdles: While some Republicans have supported addressing market concentration in pharmacy benefits, broader bipartisan agreement on tackling vertical integration in healthcare remains elusive. Critics argue that UnitedHealth’s influence extends beyond typical insurer roles, enabling it to manipulate prices and undermine competition. Policymakers, however, face challenges in balancing reform efforts with political dynamics, especially as Medicare Advantage remains a favored program among many lawmakers.

Eli Lilly’s Zepbound Becomes First FDA-Approved Drug Therapy for Sleep Apnea

By Frank Vinluan - Sleep apnea, a sleep disorder typically managed with a medical device that aids in breathing, now has its first FDA-approved drug therapy, an Eli Lilly medicine initially developed as a treatment for metabolic conditions. Read Full Article… 

HVBA Article Summary

1. FDA Approval and Usage: The FDA has approved Lilly's tirzepatide, branded as Zepbound, for the treatment of moderate-to-severe obstructive sleep apnea (OSA) in adults with obesity. This once-weekly injectable medication is to be used in combination with a reduced-calorie diet and exercise, similar to its applications for type 2 diabetes and weight management. It is the first medication to significantly address both OSA and long-term weight loss.

2. Clinical Trial Results and Efficacy: Zepbound's approval is based on Phase 3 trials involving 469 adults, which demonstrated significant reductions in apnea events and body weight (18-20%) over 52 weeks compared to placebo groups. The studies also highlighted its potential for use as a front-line therapy, with concurrent CPAP and Zepbound treatment showing promise for enhanced efficacy.

3. Market Impact and Future Potential: Zepbound's approval opens new competitive challenges for CPAP manufacturers and adds a blockbuster opportunity for Lilly, as sleep apnea affects approximately 25 million U.S. adults. With the drug generating billions in revenue under its diabetes and weight management indications, additional applications for conditions like fatty liver disease and cardiovascular health are in Lilly’s pipeline.

12 key insurance industry lawsuits in 2024

By Jacob Emerson - From antitrust challenges from the federal government over proposed acquisitions, to industrywide disputes over Medicare Advantage star ratings, these are 12 key insurance industry lawsuits filed or settled in 2024. Read Full Article…

HVBA Article Summary

1. Legal Challenges to CMS Medicare Advantage Ratings: UnitedHealthcare's successful lawsuit against CMS regarding the 2025 Medicare Advantage star ratings methodology highlights ongoing disputes over the agency's evaluation practices. Other insurers like Humana and Centene have also contested CMS's use of tactics such as "secret shopper" calls, reflecting broader industry pushback on regulatory oversight and its financial implications, including over $1 billion in adjusted payments following SCAN Health Plan's earlier legal victory.

2. Antitrust and Fiduciary Duty Cases Reflect Industry-Wide Scrutiny: The healthcare sector faces intensified legal scrutiny, as evidenced by lawsuits involving antitrust concerns (e.g., DOJ's challenge to UnitedHealth's Amedisys merger and BCBS's $2.67 billion settlement over market allocation allegations) and fiduciary duty violations (e.g., BCBS Minnesota's ERISA-related case and Owens & Minor's lawsuit against Anthem). These cases underscore the rising focus on regulatory compliance and ethical governance in payer operations.

3. Settlements Highlight Financial and Ethical Accountability: Notable settlements, such as UnitedHealth's $69 million payout over 401(k) mismanagement and Aetna and Optum's class-action suit regarding billing practices, emphasize the financial consequences of ethical lapses. These resolutions, alongside large-scale agreements like BCBS's $2.8 billion settlement with healthcare providers, reveal the significant monetary and reputational stakes for healthcare organizations in resolving legal disputes.

Personalizing Benefits For A Four-Generation Workplace

By Tim Pratte and Forbes Business Council - How can organizations design benefits that meet the diverse needs of a four-generation workforce while also ensuring employees engage with the right options at the right time? The answer is in personalized benefits and strategic communication. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Personalization is Key to Modern Benefits: Employees today span four generations, each with unique needs and priorities, from mental wellness and telehealth for Gen Z to financial stability for Baby Boomers. Personalizing benefits and communication based on career stage and life events ensures employees feel supported, enhancing satisfaction and retention.

2. Effective Communication Drives Engagement: Gone are the days of passive, once-a-year benefits enrollment. Regular, tailored communication throughout the year—leveraging decision-support tools, multiple channels, and manager-led discussions—empowers employees to make informed choices, boosting engagement and cost efficiency.

3. Benefits as a Strategic Advantage: Benefits are no longer transactional; they’re pivotal to shaping employee experience and loyalty. Companies that adapt by embracing personalized, technology-driven benefits strategies will position themselves as leaders in talent retention and workforce satisfaction.

Medicaid spending on weight loss, diabetes drugs up 500% since 2019: 5 numbers to know

By Rylee Wilson - Medicaid could spend $29.9 billion on drugs to treat type 2 diabetes and weight loss, according to a report from HHS' Office of Inspector General. Read Full Article…

HVBA Article Summary

1. Explosive Spending Growth: Medicaid spending on 12 diabetes and weight loss drugs surged by over 500% from 2019 to 2023, rising from $1.5 billion to $9.4 billion, reflecting the increasing reliance on high-cost treatments like GLP-1 and SGLT-2 drugs.

2. Weight Loss Drug Costs: In 2023, Medicaid spent $562.5 million on two GLP-1 drugs, Wegovy and Saxenda, underscoring the growing financial impact of weight loss medications on the program's budget.

3. Rising Prescription Claims: Medicaid claims for diabetes drugs increased by 333%, growing from 2.4 million in 2019 to 10.5 million in 2024, highlighting a sharp rise in demand for these medications.

Why Walgreens Is Reportedly Considering a Private Equity Buyer

By Marissa Plescia - Is anyone surprised that Walgreens is looking to sell itself — reportedly to private equity firm Sycamore Partners? Walgreens has been losing a lot of greenbacks lately: a whopping $8.6 billion of them in fiscal 2024. Its foray into primary care has been a challenge forcing it to close a series of VillageMD clinics nationwide. Read Full Article… 

HVBA Article Summary

1. Challenges Facing Walgreens: Walgreens has struggled with competition from online pharmacy retailers like Amazon Pharmacy and Mark Cuban's Cost Plus Drugs, combined with the pressure of drug price negotiations. These challenges, coupled with the mature and low-margin nature of the pharmacy business, have significantly diminished the company's market value—from over $100 billion to below $8 billion in the last decade.

2. The Case for a Private Equity Sale: A private equity buyout, such as the rumored interest from Sycamore Partners, offers Walgreens a potential pathway to streamline operations, close underperforming locations, and focus on profitable segments like retail health and beauty. Experts suggest this move could allow Walgreens to restructure and innovate without the short-term pressures of Wall Street reporting, possibly stabilizing its business and paving the way for growth.

3. Skepticism and Uncertainty: Despite the potential benefits, concerns remain about the feasibility of a private equity deal due to Walgreens' substantial debt and limited cash flow. While Sycamore Partners’ retail focus could align with Walgreens' needs, analysts question whether it or another buyer could successfully navigate the complex restructuring required to revitalize the struggling giant.

Drugs like Ozempic now make up 5% of prescriptions in the US

By Antonio Regalado - US doctors write billions of prescriptions each year. During 2024, though, one type of drug stood out—“wonder drugs” known as GLP-1 agonists. As of September, one of every 20 prescriptions written for adults was for one of these drugs, according to the health data company Truveta. Read Full Article…

HVBA Article Summary

1. Rapid Popularity Growth and Accessibility Challenges: GLP-1 drugs like Wegovy, Mounjaro, and Victoza gained immense popularity in 2024 due to their dual ability to treat diabetes and aid significant weight loss by suppressing hunger signals. Prescription rates soared from 1% in 2021 to 5.4% in September 2024. However, accessibility remains a challenge, with half of obesity-related prescriptions going unfilled due to high costs and limited insurance coverage, leaving a significant gap between demand and actual usage.

2. Emerging Potential for Treating Other Conditions: Researchers are exploring the broader applications of GLP-1 drugs, with promising signs for treating Alzheimer’s disease, addiction, and sleep apnea. For example, early studies suggest semaglutide may lower Alzheimer’s risk by up to 70%, while anecdotal and research findings indicate potential benefits for reducing cravings and improving sleep apnea symptoms. Such discoveries highlight the drugs' potential to address diverse health challenges.

3. Implications for Longevity and Public Health: GLP-1 drugs have shown potential for enhancing longevity, with FDA approval of Wegovy as a cardiovascular medicine after demonstrating a 19% reduction in all-cause mortality. These findings, combined with their widespread usage, position these drugs as transformative not only for weight loss but also for improving public health outcomes and possibly extending lifespan.